PATIENT CAST CARE

General Information

Casts are used to help immobilize an injured part of the body after fractures, surgery, or other injuries. Splints are “half-casts” that immobilize the fracture, although not as rigidly as a full cast. Splints allow for swelling while immobilizing a fracture. They are usually used in the immediate post-injury or post-operative period, before changing to a cast.

Taking Care of your Cast

Keeping your cast in GOOD condition and as CLEAN and DRY as possible, will help your recovery and keep you as comfortable as possible.

• Keep your cast dry. Damp padding next to the skin will lead to foul smell, itchiness, and skin irritation.
• Keep dirt, sand and powder away from the inside of your splint or cast. The will help prevent foul smell, itchiness, and skin irritation.
• Do not weight bear or lay your cast on a hard surface for at least 30 minutes to allow the cast to dry in the proper mold.
• Do not pull padding away from your splint or cast. The padding is there to help protect your skin from the edges of the fiberglass. Inspect your skin regularly around the cast, and if the skin becomes red or raw around the cast, contact your doctor.

Itching inside a Cast

Itching is a common yet frustrating problem for a person with a cast, especially during hot weather.

• Even if you can reach the itchy area, do not scratch the skin inside the cast. Because the skin is in a hot, moist environment, it is susceptible to damage. Scratching is more likely to injure the skin than under normal circumstances and increase the itchiness.
• Do not put anything in the cast, especially to itch. Using objects or toys to scratch is a major concern with young children. A lodged object in a child’s cast can cause a pressure sore in addition to a possible infection.
• Do not apply powders or deodorant to your itchy skin. This will only increase the itchiness.
• If surgery was performed and there is an incision, consult your doctor for pain medication or medication to reduce itching. Using a hairdryer (with the temperature setting on cold) over the area may also reduce the itchiness, whether or not an incision is there.
• You may use over-the-counter antihistamines if the itching is severe. If the itching persists, contact your doctor.

Care of the Patient in a Cast

Whenever possible, raise the body part enclosed in the cast ABOVE the height of your heart. This decreases the likelihood of excessive swelling of the tissues underneath the cast. Swelling is simply fluid that will “run downhill”, so it is important that the whole limb is elevated adequately. Elevate a leg cast on as much as possible throughout the day, and when in bed, with the foot higher than your knee, and the knee higher than your heart. Rest an arm cast as much as possible through the day, and on a pillow placed on the chest when is bed, elevating the hand higher than the elbow, and the elbow higher than your heart.

No matter how carefully the injured tissues are handled and no matter how expertly the cast is applied, it is still possible for excessive swelling to occur under the cast. If this happens, one or more of the following will probably become noticeable:

• Severe and persistent pain.
• Change in color of the tissues beyond the end of the cast, such as a change to blue or gray under the nails of the fingers or toes.
• Coldness of the tissues beyond the cast when the rest of the body is warm.
• Numbness or complete loss of feeling in the skin beyond the cast.
• Feeling of tightness under the cast after it dries.
• Swelling of the tissue to a greater extent that was present before the cast was applied.
• For a leg cast, inability to raise the big toe.

If any of these signs or symptoms occur, the treatment is the same. ELEVATE the limb above the height of your heart. Contact your doctor if these signs or symptoms do not go away after a prolonged period (1-2 hours) of ADEQUATE elevation. It is possible and likely that swelling fluctuates throughout the day depending on the body position that you are in.

Infection Inside a Cast

Sometimes the injured area becomes infected during healing. Detecting the infection in the early stages may be difficult if the infected area is covered by a cast. Infection should be reported immediately to your doctor. The following are common signs and symptoms of infection:

• Foul smell
• Fever greater than 101°F (may be accompanied by a general ill feeling)
• Leakage of fluid through the cast
• Increasing pain or soreness of the skin under the cast

Remember that “itching” with any type of object under the skin, increases the chance of infection.

Bathing with a Cast

You may find bathing difficult when wearing a cast. The cast must be kept dry at all times, so do not take showers. If the cast is on a limb, such as your arm or leg, you may take tub baths with the casted extremity propped up on the side of the tub or a chair, out of the water. If the cast is on the trunk of the body, you should take sponge baths until the cast is removed. Use durable plastic bags and elastic bands to help keep your cast dry. You may also consider purchasing a “cast protector” or “cast shower bag” from your local pharmacy.