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Cast and splint care

Casts and splints provide support and protect injured bones and soft tissues. When a bone is broken, your doctor will put the parts back together in the proper position. Casts and splints hold the bones in place until they knit together. They also reduce pain, swelling and muscle spasms. In some cases, casts and splints are placed after surgery. Splints or casts provide less support than casts. However, splints can be adjusted for swelling from injuries more easily than closed casts. Your doctor will decide the type of support that is best for you.

Types of splints and casts Casts are custom-made. They must be properly adapted to the shape of the injured limb to provide the best support. Casts can be made of plaster or fiberglass (a plastic that can be shaped).

Splints or half casts can also be custom-made, especially if an exact fit is needed. At other times, a prefabricated splint is used. These ready-to-use splints are made in a variety of shapes and sizes and are much easier and quicker to use. Some have Velcro straps that make putting on, taking off and adjusting the splints easier.

Materials In splints and casts, fiberglass or gypsum materials form the solid support layer. Fiberglass is lighter and stronger than plaster. In addition, X-rays pass through fiberglass better than plaster. This is important because your doctor will probably schedule additional x-rays after the cast or splint is placed. X-rays can show if the bones are healing well or if they have moved out of place. The cast is less expensive than fiberglass and allows for better shaping than fiberglass for some uses.

Application Both fiberglass and gypsum casts and splints have a padding pad, usually made of cotton, as a protective layer in contact with the skin. Both materials come in strips or rolls, soaked in water, and applied over the protective pad covering the injured area. In some cases, special waterproof plaster and filler materials may be used. Your physician will inform you if your cast and padding are made of these waterproof materials.

The splint or cast must conform properly to the shape of the injured arm or leg to provide the best possible support. In general, the splint or cast also covers the joint above and below the fractured bone. In many cases, a splint is first applied to a fresh injury. As the swelling goes down, the splint may be replaced with a full cast. If a cast is initially applied to the injury, it may be “opened” (cut open) to accommodate the swelling and then repaired at your first follow-up appointment.

Sometimes a cast may need to be replaced because swelling goes down and the cast becomes too large. As a fracture heals, the cast may be replaced with a splint to make it easier to perform physical therapy exercises.

Getting used to a splint or cast Swelling caused by the injury may cause pressure in the splint or cast for the first 48 to 72 hours. This may cause your injured arm to feel tight or constricted inside the splint or cast. If you have a splint, your doctor will show you how to adjust it to accommodate swelling. It is very important to keep the swelling down. This will reduce pain and help your injury heal.

To help reduce inflammation: Elevate. It is very important to elevate the injured arm or leg for the first 24 to 72 hours. Rest the injured arm or leg on pillows or other support so that it is above the level of your heart. You will need to lie down if you have a splint or cast on your leg. Elevation allows fluid and blood to drain “down” to the level of the heart. Exercise. Gently and frequently move your uninjured but swollen toes. Moving them will prevent stiffness. Ice. Apply ice to the splint or cast. Place the ice in a dry plastic bag or use an ice pack and wrap it around the splint or cast at the level of the injury. If the ice is placed in a rigid container and touches the cast only in one spot, it will not be effective.

Warning signs Swelling can create a lot of pressure under the cast. This can cause problems. If you have any of the following symptoms, contact your doctor’s office immediately for guidance. Increased pain and a feeling that the splint or cast is too tight. This may be due to swelling. Numbness and tingling in the hand or foot. This may be due to excess pressure on the nerves. Burning and stinging. This may be due to excess pressure on the skin. Excessive swelling under the cast. This may mean that the cast is slowing blood circulation. Loss of active movement of the fingers or toes. This requires urgent evaluation by your doctor.

Caring for your splint or cast Your doctor will explain any restrictions on the use of your injured arm or leg while it is healing. You should carefully follow your doctor’s instructions to make sure that the bone is welded properly. The following information presents general guidelines only and does not replace your doctor’s recommendations.

After you have been adjusting to your splint or cast for a few days, it is important to keep it in good condition. This will aid in your recovery.

Keep your cast or splint dry. Moisture weakens the cast, and if the pad on your skin gets wet, it can cause irritation. Use two layers of plastic or buy waterproof pads to keep your cast or splint dry when showering or bathing. Even if the cast is covered, do not submerge it or hold it under water. A small hole in the cast cover can cause the wound to get wet. Walking casts. Do not walk with a walking cast until it is completely dry and firm. It takes about an hour for the fiberglass to harden enough to walk on, and the cast may take two to three days. You will be given a cast shoe to wear over the walking cast. The plaster shoe will protect the underside of the cast. Avoid dirt. Keep your splint or cast away from dirt, sand and dust. Protective pad. Do not remove the pad from your cast or splint.

Itching. Do not insert objects, such as hangers, into the splint or cast to scratch itchy skin. Do not apply powders or deodorants to itchy skin. If itching persists, contact your doctor. If something gets stuck inside your cast, it can irritate the skin, so contact your doctor.

Do not break the irregular edges of the cast or trim the cast before asking your doctor. Inspect the skin near the cast. If the skin becomes red or raw near the cast, contact your doctor.

Inspect the cast regularly. If it breaks or soft spots form, contact your doctor’s office.

Use common sense. You have a serious injury and should protect the cast from damage so that it can protect your injury while it heals.

After the initial swelling goes down, proper support from the splint or cast will generally allow you to continue your daily activities with a minimum of discomfort.

Removing the cast Never remove the cast yourself. You may cut your skin or prevent your injury from healing. Your doctor will use a cast saw to remove it. The saw vibrates but does not rotate. If the saw blade touches the pad on the inside of the hard cast liner, the pad will vibrate with the blade and protect your skin. Plaster saws make noise and may produce heat from friction, but they will not hurt you; as the saying goes, a barking dog won’t bite. If you feel pain while the cast is being removed, tell your doctor or an assistant, and they can make adjustments.

Rehabilitation It takes weeks to several months for the broken bones to heal. The pain usually goes away long before the bone is strong enough to withstand the stress of daily activities. You will need to wear the cast or splint until the bone is fully healed and can support its own weight.

While wearing the cast or splint, you will probably lose muscle strength in the injured area. It is important to exercise during the healing process and after the cast is removed. Exercise will help you regain normal muscle strength, joint movement and flexibility.

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