Cast Care

Cast Care: 

A cast is a medical device that supports and protects an injured bone as it heals. It can also help prevent muscle contractions and provide immobilization, especially after surgery. When a child breaks a bone, doctors often use a cast to immobilize the joint above and below the area of the injury. For example, a child with a broken arm might have a long arm cast that immobilizes the wrist and elbow joints.

But without proper care, a cast can’t do its job. So, let’s know the basics about cast care.

What are the Different Types of Casts?

There are various types of casts and your doctor will customize one to fit and support the injured limbs. The two main types of casts are:

• Plaster casts – For several uses plaster casts are easier to mold than fiberglass casts. Also, plaster casts are usually less expensive.
• Fiberglass casts – These are plastic casts and are generally lighter and more durable than plaster casts. Also, X-rays penetrate fiberglass casts better than plaster casts which makes it easier for doctors to examine patients’ bones while he or she still wearing the cast.

The other types are: 

• Cast brace – This is made of hard plastic and soft pads inside the brace that compress the injury. Velcro strips help the brace stay in place and these are removable. Doctors may use a cast brace right after the injury occurs. Or, they may also use it toward the end of healing, after removing another cast.
• A splint (also called a half-cast) – This is made from fiberglass or slabs of plaster that hold the injury in place. Then doctors wrap a bandage around the injury to hold the plaster slabs in place. Splints are suitable when swelling is present, or the patient has a risk of swelling. Mostly, experts replace the splint eventually with another type of cast.

Application

Both fiberglass and plaster splints and casts come with cotton padding as a protective layer right next to the skin. Sometimes, special waterproof padding and cast material are also there.

The splint or cast should properly fit the shape of the injured limbs to ensure the best possible support. Usually, the splint or cast also covers the joint above and below the broken bone.

In many cases, doctors first use a splint for a fresh injury. And as swelling reduces, they may replace the splint with a full cast. In other cases, if they initially apply a cast it may have a cut to allow for swelling. Then they will repair or replace the cut during the first follow-up appointment.

Then after that, as the fracture heals, experts may replace the cast with a splint to make performing physical therapy and exercises easier.

How to Reduce Swelling?

Swelling can cause the cast to feel tight and uncomfortable. To reduce the swelling parents should do the following:

• Elevate the fractured area – For the first 24 to 72 hours after applying the cast, use pillows to raise the cast above the level of your child’s heart. Your child will need to lay back in a relaxed position if the cast is on a leg.
• Apply ice – Place an ice pack covered with a thin towel around the injured area and loosely wrap it in place. Avoid applying ice directly to the cast and repeat the process as needed.
• Keep moving – Encourage your child to move the toes and fingers of the injured limb frequently.

What to do if there is Itching Under the Cast?

It is common for a child’s skin to feel itchy under a cast. To alleviate this discomfort, parents can use a hair dryer in a cool setting to gently blow air under the cast. It is important not to allow your child to insert any objects, such as a coat hanger, inside the cast to scratch the skin. This can cause injury or infection.

Can Infections Occur?

It is normal for a cast to develop a smell after it’s worn for an extended period. However, if parents notice a strong, foul odor or a discharge coming from the cast, it could be a sign of infection underneath the skin. In such cases, parents should consult their doctor for quick evaluation and treatment.

Cast Care and Keeping it Dry

To keep a child’s cast dry, cover it with two layers of plastic and seal it with a rubber band or duct tape during baths or showers. Only certain types of breaks can be treated with a fiberglass cast that has a waterproof liner. Consult a healthcare provider to determine if it is safe for the child’s cast to get wet. If the cast gets wet, use a hair dryer on a low heat setting to dry out the inside padding.

How can my Child Move Around with a Cast?

In such situations, assistive devices for children with casts include:

• Wagons
• Wheelchairs
• Crutches
• Walkers
• Reclining wheelchairs

How to Keep My Child’s Cast In a Good Shape?

Follow these Cast Care tips:

• Keep the dirt and sand away from your child’s cast.
• Do not apply powder, lotion, or deodorant near or on the cast.
• Avoid breaking off the rough edges or trimming the cast without consulting your child’s doctor. Also, don’t pull the padding out of the cast.
• Look for cracks or breaks in the cast.
• Do not let your child put small toys or objects inside the cast.
• Elevate the limb with a cast above heart level to decrease swelling.
• Encourage your child to frequently move his or her fingers or toes since it will promote blood circulation.
• Avoid using the abduction bar on the cast to lift or carry the child.
• Doctors can pad the rough edges to prevent scratches on the skin.
• Don’t let your child scratch the skin under the cast by putting objects inside the cast.
• Try to cover up the cast while your child is eating. It will prevent food spills and crumbs from entering the cast.

Cast Care and Body Casts 

Older children with body casts may need a bedpan. Tips to keep body casts in good shape and prevent skin irritation around the genital area are given below:

• Keeping the genital area as clean and dry as possible will prevent skin irritation.
• To prevent leakage or splashing of urine, use a diaper or sanitary napkin around the genital area.
• Parents can prevent urine from splashing onto the cast or bed by placing toilet paper inside the bedpan.

Immediately Contact Your Child’s Doctor If:

• There is increasing pain and tightness in the injured hand or leg
• Numbness or tingling in the injured limb
• Burning or stinging sensation under the cast
• Excessive swelling below the cast
• Inability to move the toes or fingers of the injured limb or they become blue or cold
• The cast feels too loose or tight
• Red or raw skin growth around the cast
• A crack, soft spots, foul odor in the cast, or the cast is soaking wet and is not dried properly

Well, caring for a child’s cast may not always be easy. Keep reminding your child that taking care of the cast will reduce and prevent discomfort during the healing procedure.

Cast Care and Removal

Parents should never try to remove a cast. Parents could accidentally cut their child’s skin or disrupt the proper healing process of their child’s injury. Your doctor will use a special tool called a cast saw to safely remove the cast. The saw vibrates but does not rotate. And the padding inside the hard shell of the cast will protect the skin from the blade.

Although the saw may make noise and feel hot from friction, it will not cause any harm. If your child experiences any pain during the cast removal process, let your doctor or an assistant know so they can make adjustments.

Cast Care Conclusion 

Your child will have to wear a cast or splint until the bone is fully healed and able to support itself. While your child is wearing the cast or splint, your child may lose muscle strength around the injured area. To deal with this, patients should exercise during the healing process and after the removal of the cast. And remember in case your child feels any discomfort with the cast, consult with your child’s doctor and parents should never do anything themselves.

The doctors and surgeons at Medical City Children’s Orthopedics and Spine Specialists have offices in Arlington, Dallas, Frisco, and McKinney, TX and have been caring for children with broken bones for decades.  Emergency rooms refer patients to us as we are skilled in healing children with broken bones.  If your child has a broken bone and needs a cast, we urge you to give us a call.  We see your child in an expedited manner.

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American Academy of Orthopedic Surgeons: Cast Care
Family Doctor: Cast Care