Cast Care

Fracture
A fracture is a break of the bone. It occurs when bone is subjected to more stress than it can absorb. Fractures can occur at any age. Signs and symptoms can vary depending upon the site of injury, the type, of fracture, and the amount of trauma that has been sustained by the bone and surrounding tissue. To confirm that a fracture is present, an x-ray will be done.

Casts are most often used to help mend broken bones. They (1) immobilize the injury, (2) protect an area recovering from a fracture or surgery, and (3) reduce pain caused by motion and relieve discomfort.

The healing time for a fractured bone will depend on the type of fracture, the kind of bone (such as arm or leg) and the person's age. Children usually heal much faster than adults. Most fractures will heal in approximately 6-8 weeks. During this period, your cast may be changed several times.

Special care is required for the first 48 hours following the injury. To reduce swelling in the afflicted area:

• Elevate the casted extremity above the level of your heart. Having your arm in a sling is not enough. Prop your elbow above your chest, hand above your elbow. The Physician may have you use an I.V. Pole sling for a few days to assist with elevation of the arm.
• Wiggle your fingers or toes frequently to improve circulation. You may experience discomfort when moving the fingers or toes but this is very important.
• Rest and take it easy. You can resume most activities in a few days with your doctor's permission.

Be alert for these warning signs and report them immediately to your physician or return to the Emergency Room:

1. Pain that is not relieved by elevation or pain medications.
2. Swelling of fingers or toes causing the cast to feel too tight.
3. Change in sensation (numbness, tingling).
4. Unusual coolness or lack of color
5. Persistently blue nail beds.

Plaster Cast
Your first cast will usually be made plaster. It takes approximately 24-48 hours to dry. Handle it with care. Keep it uncovered to allow it to dry completely. Avoid resting it on hard or sharp surfaces in order to prevent a dent or soft spot from forming and causing a sore to develop inside the cast. Do not stand on a walking cast until it is completely dry and your doctor allows it! A plaster cast must never get wet.

Synthetic (Fiberglass) Cast with Cotton Liner
This cast is completely dry in 15 minutes. It is usually lighter and stronger than the plaster cast; you may walk on it almost immediately, if your doctor allows. This cast should never get wet!

Synthetic (fiberglass) Cast with GORE-TEX Liner
This cast is dry in 15 minutes. It is the only cast that may get completely wet. You may bathe regularly and swim without covering the cast. Be sure to rinse the cast with clean water to remove chlorine, soap, and other substances. No special drying procedures are necessary after wetting. Most of the water will drain quickly out the ends of your cast. For arm cast put the arm to your side with the fingers pointing to the floor to allow water to drain from the cast for 5 minutes. For leg cast lay on your stomach for 10 minutes to allow the water to drain from the heel to the toes. The remaining water on your skin will be warmed by your body heat and evaporate through the liner and cast. Do not cover the cast while it is drying. Most casts will feel dry within one hour.

Ongoing Care

1. Examine the cast daily for cracks and/or soft spots. Patients should not participate in P.E. at home or at school unless instructed to by their physician. Check the skin for redness, blisters or sores along the cast edges and be alert to any bad odor from the cast. If you are uncertain about anything, contact the orthopaedic nurse or your physician.
2. Remind your child not to scratch or push anything down inside the cast. Keep small objects that could easily slip into the cast away from the young child. These objects may cause a skin breakdown and lead to a serious infection. Do not use lotion or powder inside the cast. If itching persists, you may use a non-prescription medication such as Benadryl. Dosage will vary with the child's age and weight so consult the pharmacist for the appropriate amount for your child.
3. An anti-inflammatory such as Advil or Pediaprofen should be taken for 3-5 days following the injury. Pain medication may also be prescribed for more severe pain and discomfort. It is not unusual for the child to run a slight temperature(100) for 2-3 days following the injury.

Follow-up Office Visits

X-rays will be taken to determine when healing is complete. These films can be taken through the cast.

The cast may be changed if it becomes loose or if some healing has occurred and a shorter cast can be used. A special saw will be used to remove the cast.

When the fracture has healed your cast will be removed. You may notice stiffness, swelling and some discomfort at first. These symptoms are normal and should improve in 2-3 weeks. Patience is the best treatment. Don't overdo exercise or other physical activities.

For Further information regarding your care:

205-638-5785 — MONDAY THROUGH FRIDAY 8AM-4PM FOLLOW-UP APPOINTMENTS
205-638-6208 — MONDAY THROUGH FRIDAY 8AM-5PM ORTHOPAEDIC CLINIC/NURSE
205-638-9836 — PEDIATRIC ORTHOPAEDICS OFFICE

If you have any questions regarding the cast during the evenings and weekends please do the following:

Call 205-638-9100 and ask to have the Orthopaedic Resident paged to "your" number.