Cast Types and Maintenance Instructions

What is a cast?
A cast holds a broken bone in place as it heals. Casts also help to prevent or decrease muscle contractions, and are effective at providing immobilization, especially after surgery. Casts immobilize the joint above and the joint below the area that is to be kept straight and without motion. For example, a child with a forearm fracture will have a long arm cast to immobilize the wrist and elbow joints.

What are casts made of?

The outside, or hard part of the cast, is made from two different kinds of casting materials.

plaster - white in color. fiberglass - comes in a variety of colors, patterns, and designs.

Cotton and other synthetic materials are used to line the inside of the cast to make it soft and to provide padding around bony areas, such as the wrist or elbow. Special waterproof cast liners may be used under a fiberglass cast, allowing the child to get the cast wet. Consult your child's physician for special cast care instructions for this type of cast.

What are the different types of casts?

Below is a description of the various types of casts, the location of the body they are applied, and their general function.

Type of Cast Short arm cast: Long arm cast: Arm cylinder cast:

Location Applied below the elbow to the hand. Applied from the upper arm to the hand. Applied from the upper arm to the wrist.

Uses Forearm or wrist fractures. Also used to hold the forearm or wrist muscles and tendons in place after surgery. Upper arm, elbow, or forearm fractures. Also used to hold the arm or elbow muscles and tendons in place after surgery. To hold the elbow muscles and tendons in place after a dislocation or surgery. Illustrations of arm casts, 3 types

Click Image to Enlarge

Type of Cast Shoulder spica cast:

Location Applied around the trunk of the body to the shoulder, arm, and

Uses Shoulder dislocations or after surgery on the shoulder area.

hand. Minerva cast: Short leg cast: Leg cylinder cast: Applied around the neck and trunk of the body. Applied to the area below the knee to the foot. Applied from the upper thigh to the ankle. After surgery on the neck or upper back area. Lower leg fractures, severe ankle sprains/strains, or fractures. Also used to hold the leg or foot muscles and tendons in place after surgery to allow healing. Knee, or lower leg fractures, knee dislocations, or after surgery on the leg or knee area.

Illustrations of leg casts, 3 types

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Type of Cast Unilateral hip spica cast: One and onehalf hip spica cast: Bilateral long leg hip spica cast:

Location Applied from the chest to the foot on one leg.

Uses Thigh fractures. Also used to hold the hip or thigh muscles and tendons in place after surgery to allow healing. Thigh fracture. Also used to hold the hip or thigh muscles and tendons in place after surgery to allow healing. Pelvis, hip, or thigh fractures. Also used to hold the hip or thigh muscles and tendons in place after surgery to allow healing.

Applied from the chest to the foot on one leg to the knee of the other leg. A bar is placed between both legs to keep the hips and legs immobilized. Applied from the chest to the feet. A bar is placed between both legs to keep the hips and legs immobilized.

Illustrations of hip spica casts, 3 types

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Type of Cast

Location

Uses

Short leg hip spica cast:

Applied from the chest to the thighs or knees.

To hold the hip muscles and tendons in place after surgery to allow healing.

Illustration of child wearing a short leg hip spica cast

Click Image to Enlarge

Type of Cast Abduction boot cast:

Location Applied from the upper thighs to the feet. A bar is placed between both legs to keep the hips and legs immobilized.

Uses To hold the hip muscles and tendons in place after surgery to allow healing.

Illustration of child wearing abduction boots

Click Image to Enlarge

How can my child move around while in a cast?

Assistive devices for children with casts include:

crutches walkers wagons wheelchairs reclining wheelchairs

Cast care instructions:

Keep the cast clean and dry.

Check for cracks or breaks in the cast. Rough edges can be padded to protect the skin from scratches. Do not scratch the skin under the cast by inserting objects inside the cast. Can use a hairdryer placed on a cool setting to blow air under the cast and cool down the hot, itchy skin. Never blow warm or hot air into the cast. Do not put powders or lotion inside the cast. Cover the cast while your child is eating to prevent food spills and crumbs from entering the cast. Prevent small toys or objects from being put inside the cast. Elevate the cast above the level of the heart to decrease swelling. Encourage your child to move his/her fingers or toes to promote circulation. Do not use the abduction bar on the cast to lift or carry the child.

Older children with body casts may need to use a bedpan or urinal in order to go to the bathroom. Tips to keep body casts clean and dry and prevent skin irritation around the genital area include the following:

Use a diaper or sanitary napkin around the genital area to prevent leakage or splashing of urine. Place toilet paper inside the bedpan to prevent urine from splashing onto the cast or bed. Keep the genital area as clean and dry as possible to prevent skin irritation.

When to call your child's physician:

Contact your child's physician or healthcare provider if your child develops one or more of the following symptoms:

fever greater than 101 F increased pain increased swelling above or below the cast complaints of numbness or tingling drainage or foul odor from the cast cool or cold fingers or toes

Fracture Treatment Bone is constantly in a state of turnover, even when not damaged or injured. We continually absorb and replace the cells that make up our bones. Because of this natural turnover, the process of healing bone also comes about quite naturally. However, in order for a fracture to heal as well as possible, a good reduction, or placement, of the bones must be attained.

When doctors talk about reduction or a fracture, orreducing the broken bone, they are talking about improving the alignment of the broken ends of the bone.

In most cases reducing a fracture involves placing the broken bone in a cast, often after a little pulling and tugging to achieve improved alignment. If the reduction cannot be satisfactorily achieved (meaning the alignment is either not adequate or not sufficiently stable), then a further procedure may be necessary. This usually means surgery with fixation of the bone with pins, plates, screws or rods. One potential complication of fracture treatment is either a mal-union or non-union of bone. This problem is more common in elderly individuals and in people who sustain more severe fractures. In the case of some fractures (e.g. hip fracture in elderly) the rate of non-union is high enough that instead of trying to heal the bone, the damaged segment of bone is replaced (e.g. hip replacement). The treatment of a specific fracture is too complicated to be discussed in a general overview of broken bones, but depends on factors such as:

Location of the fracture Severity of angulation or deformity Potential for healing Other injuries Age and activity level of the patient And many more factors....

In order to understand your treatment, and the options you may have for treatment, you need to discuss your fracture with your doctor. Because treatments are individualized based on the patient, the x-ray appearance of the fracture, and the other factors mentioned, each case must be treated individually. Underlying Problems The most common cause of fractures is due to trauma. However, especially in the elderly, broken bones often occur where the bone has been weakened by an underlying process. This is called a "pathologic fracture," which means that there is some pathology, or disease process, that caused the bone to be weak and highly susceptible to fracture. Common diseases that lead to pathologic fracture include osteoporosis and tumors

Four-Point Crutch Gait

Indication: Weakness in both legs or poor coordination.

Pattern Sequence: Left crutch, right foot, right crutch, left foot. Then repeat.

Advantages: Provides excellent stabilty as there are always three points in contact with the ground

Disadvantages: Slow walking speed

Three-Point Crutch Gait

Indication: Inability to bear weight on one leg. (fractures, pain, amputations)

Pattern Sequence: First move both crutches and the weaker lower limb forward. Then bear all your weight down through the cruthes, and move the stronger or unaffected lower limb forward. Repeat.

Advantages: Eliminates all weight bearing on the affected leg.

Disadvantages: Good balance is required.

Two-Point Crutch Gait

Indication: Weakness in both legs or poor coordination.

Pattern Sequence: Left crutch and right foot together, then the right crutch and left foot together. Repeat.

Advantages: Faster than the four point date.

Disadvantages: Can be difficult to learn the pattern.

Swing-Through Crutch Gait

Indications: Inability to fully bear weight on both legs. (fractures, pain, amputations)

Pattern Sequence: Advance both crutches forward then, while bearing all weight down through both crutches, swing both legs forward at the same time past the crutches.

Advantage: Fastest gait pattern of all six.

Disadvantage: Energy consuming and requires good upper extremity strength.

Swing-To Crutch Gait

Indications: Patients with weakness of both lower extremities.

Pattern Sequence: Advance both crutches forward then, while bearing all weight down through both crutches, swing both legs forward at the same time to (not past) the crutches.

Advantage: Easy to learn.

Disadvantage: Requires good upper extremity strength.

Tripod Crutch Gait

Indications: Initial pattern for patients with paraplegia learning to do swing to gait pattern.

Pattern Sequence: Advance the left crutch, then the right crutch, then drag both legs to the crutches

Advantage: Provides good stability.

Disadvantage: Very energy consuming.