Casts are used to immobilize fractures (breaks). In most cases, the joints above and below the fracture site arecasted also to eliminate the possibility of movement that might cause further injury or discomfort. Casts can be made of plaster of Paris, fiberglass (some are available in fashion colors), plastic, or resin materials. Your doctor will determine what material is best suited for your child's type of fracture and needs. Casts made from fiberglass, plastic, or resin are lightweight, dry quickly, and can tolerate more contact with water. Water should be avoided if at all possible, as even these materials can break down.
Drying the Cast: Casts made from older types of plaster materials may take as long as 24-48 hours to dry completely. Drying can occur within minutes with new quick-drying substances. The cast must remain uncovered to allow it to dry from the inside out. Turning a child in a plaster cast (every 2-3 hours) will help to dry a body cast evenly and prevent complications. A regular fan to circulate air may be helpful. Hair dryers or heated fans should not be used as they cause the cast to dry on the outside and remain wet beneath. They may also cause burns by heat conduction (from the cast to the skin underneath).
Wet casts should be supported by a pillow and handled with the palms of the hands to prevent indenting the cast (which can cause pressure areas). A dry plaster cast makes a hollow sound when it is tapped with a finger.
During the first few hours after a cast is applied, the chief concern is that the extremity may continue to swell and cause the cast to become too tight. The cast should be elevated and sometimes ice may be applied. The extremity should be observed to ensure that the cast has not become too tight. Your nurse will be performing these assessments and can teach you how to check for color, movement, sensation, and temperature. Any sign of difficulty:---pain, swelling, discoloration (lightness or darkness) of the exposed extremity, or inability to move extremity --- should be reported to your nurse immediately. Never ignore your child's complaints. It may be the first indication of a problem.
If the cast does not have a protective edge, the raw edges of the cast may be protected with a "petaled" edge of adhesive tape or band-aids. Your nurse can demonstrate this for you.
Depending on the type of fracture, there may be some bleeding that will soak through the cast for the first few hours after surgery. The nurse will outline this area with a ball-point pen or pencil and watch it closely
Keep the extremity elevated for the first day. Check for signs and symptoms that the cast is too tight. You should also contact your doctor if the cast is too loose, as it will no longer serve its purpose.
Cutting the cast to remove it may be frightening to your child. The cast cutter is noisy and the child will be afraid that his/her skin will be cut. The cast cutter works by vibration and only cuts the hard surface of the cast. The nurse or person cutting the cast can demonstrate this for your child. However, the cast cutter does generate some heat and this may be felt by your child.
After the cast is removed, the skin surface will usually be coated with sloughed-off skin and some secretions. To help clear this up, simply soak the extremity in water for a few minutes at a time . It may take a few days, but do not attempt to scrub the material off as it may make the skin raw and bleed. Apply mild lotion or oil for comfort.
Summary of Cast Guidelines
- Keep the casted extremity elevated on pillows or a similar support for the first day, or as directed by your doctor.
- Avoid indenting the cast until it is thoroughly dry. Use the palms of your hands.
- Observe the fingers or toes for any signs of swelling; discoloration (darker or lighter than a comparable extremity); or foul odor ( a musty or foul odor can signal infection). Contact your doctor if any of these are noted.
- Follow your doctor's orders regarding any activity restriction.
- Encourage quiet activities, but encourage use of muscles.
- Move the joints above and below the cast.
- Elevate the injured extremity while resting. Avoid letting an upper extremity hang down for a length of time.
- Do not allow a child to put anything inside a cast. (Casts make an excellent hiding place for small toys or vegetables.)
- Keep small items that might be placed inside a cast away from your child.
- Remove toys, rugs, pets, etc. that might cause your child to stumble while walking with crutchs.
- Use crutches appropriately. A leg cast is heavy and can cause unsteadiness. Protect the toes and exposed parts of the foot with a sock and avoid contact with sharp or dangerous objects.
- Help itching underneath the cast by using alcohol swabs; cool air blown from a fan or cool setting on a hairdryer; or by scratching or rubbing the unaffected extremity.
- Do not let your child put anything down the cast and scratch the affected extremity. The best remedy for itching is distraction.