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CASTS

I. DEFINITION
 Externally applied structure that holds bone in one position
 Device made of layers of plaster, bandages, fiber glass or other non-plaster materials
 Plaster = also called Plaster of Paris (POP)

II. HISTORY OF CAST


 Started at ancient Indian & Egyptian medical practice
- Use of cloth bandages stiffened by egg albumin & starch paste for immobilizing
fractured limbs

III. PURPOSES OF CAST

1. Immobilize parts of the body 5. To correct deformities

2. Hold bone fragments in reduction 6. Support weakened limb

3. To apply uniform compression 7. Permits early weight bearing on affected


side
4. To stabilize joint

IV. TYPES OF CASTS


1. Plaster of Paris
2. Synthetic
a. Fiber glass cast
b. Thermoplastic cast
1. PLASTER OF PARIS (POP)
 A temporary immobilization device which is made up of gypsum sulphate anhydrous by
calcinations that swells & forms into hard cement when mixed with H20
 Natural

Indications:
a. Severly displaced function
b. Unstable function fragments
• Application: At least 24 hours to dry

Advantages of POP:

1. Low allergic response (not man-made)

2. Offers rigid protection

3. Easy to apply

4. Inexpensive

5. Shapes better than fiberglass (due to longer time)

Disadvantages
1. Long drying (24-48 hours)
2. Heavy
3. May crumble & disintegrate at edges
4. Not water proof

2. FIBERGLASS CAST
 Synthetic in form – polyurethane

Indication:
.a Non-displaced fracture
.b Fitted when swelling has subsided
.c Long term casting

Advantages :

1. Light weight – less bulky 6. Early weight bearing

2. Easy to apply 7. Radiolucent (x-ray vision can pass)

3. Moisture – proof 8.Strength: weight ration↑

4. Fast drying (15 mins) 9. Feels cooler in hot weather

5. With different colors 10. No crumble

Disadvantages
1. Application requires speed & accuracy 4. Expensive
2. May bind if tissues swell (rigid) 5. Inner layer dries slowly
3.High-risk for irritation. Tissue breakdown 6. Risk for over physical mobility – light
under the 7. Fold/ twist during change in direction
cast-extra rigidity easily

V. CONTRAINDICATIONS
 Pregnancy
 Skin diseases

VI. COMPLICATIONS OF CAST


1) Neurovascular compromise
2) Incorrect fracture alignment
3) Compartment syndrome – there is increased pressure within a limited space which
compromises the circulation & function of the tissues within the space
VII. FACTORS THAT INFLUENCE THE DURATION OF CAST
1) Patient’s age (healing process)
2) Part of the body affected – cast longer is in the big bones)
3) Degree of injury

VIII. NURSE’S ROLES TO PATIENT IN CAST


1) NV monitored
2) Preserve cast efficiently
3) Maintain/ promote integrity of the body system
• Neurovascular check:
1) Color
2) Odor
3) Motion

4) Temperature & sensation of the digits


5) Compare digits of the opposite extremity (q30)

6) Symptoms of circulatory impairment

 Coldness, edema, cyanosis, pain, & numbness in the fingers or toes


 Cyanotic fingers or toes indicate venous stasis or interference with the return flow of
blood
 Whiteness or pallor is an indication of arterial impairment