Frequently Asked Questions About Casts

Getting a cast often comes with plenty of questions. Here are answers to some frequent inquiries many parents - and kids - may have about casts:

What are the different kinds of casts?
A cast, which keeps your child's bone from moving so it can heal, is essentially a big bandage that has two layers - a soft cotton layer that rests against the skin and a hard outer layer that prevents the broken bone from moving. These days, casts are made of either:

plaster of paris - a heavy white powder that forms a thick paste that hardens quickly when mixed with water. Plaster of paris casts are heavier than fiberglass casts and don't hold up as well in water.

synthetic (fiberglass) material - made out of fiberglass, a kind of moldable plastic, these casts come in many bright colors and are lighter and cooler. The covering (fiberglass) on synthetic casts is water-resistant, but the padding underneath is not. You can, however, get a waterproof liner. The doctor putting on your child's cast will decide if he or she should get a fiberglass cast with a waterproof lining.

How is a cast put on?
First, several layers of soft cotton are wrapped around the injured area. Next, the plaster or fiberglass outer layer is soaked in water. The doctor wraps the plaster or fiberglass around the soft first layer. The outer layer is wet but will dry to a hard, protective covering. Doctors sometimes make tiny cuts in the sides of a cast to allow room for swelling.

Can plaster of paris casts get wet?
Absolutely not! A wet cast may not hold the bone in place because the cast could start to dissolve in the water and could irritate the skin underneath it, possibly leading to infection. So your child shouldn't swim and should use a plastic bag or special sleeve, which is available online or sometimes at pharmacies, to protect the cast from water. And instead of a shower, your child may need to take a sponge bath.

Can synthetic (fiberglass) casts get wet?
Although the fiberglass itself is waterproof, the padding inside a fiberglass cast is not. So it's still important to try to keep your child's fiberglass cast from getting wet. If this is a problem, talk to your child's doctor about getting a waterproof liner. Fiberglass casts with waterproof liners allow children to continue bathing or even go swimming during the healing process. Although the liner allows for evaporation of water and sweat, it's still fragile. Also, only certain types of breaks can be treated with this type of cast. Your child's doctor will determine if the fracture may be safely treated with a waterproof cast.

Is it OK to have people sign and draw on my child's cast?
Definitely! That often makes the whole broken bone experience more bearable for kids. Permanent markers usually work best; washable ones can smear. Feel free to encourage siblings, family members, and classmates to sign it, draw pictures on it, or decorate it with stickers. Your child's doctor may even let your child keep the adorned cast as a souvenir.

What if my child has an itch in the cast?
Try blowing some air in the cast with a hair dryer - be sure to use the cool setting, though. And you should never pour baby powder or oils in the cast to try to relieve your child's itch, or try to reach the itch with long, pointed object such as a pencil or hanger - these could scratch or irritate your child's skin and can lead to an infection.

What if the cast gets a crack?
This can happen if the cast is hit or crushed, has a weak spot, or if the injured area begins to swell underneath. Call your child's doctor as soon as you notice a crack. In most cases, a simple repair can be done to the cast without needing to remove it or change it.

What if the cast is causing my child's fingers or toes to turn white, purple, or blue, or if the skin around the edges of the cast gets red or raw?
The cast may be too tight. Redness and rawness are typically signs that the cast is wet inside, from sweat or water. Sometimes, children pick at or remove the padding from the edges of fiberglass casts. They shouldn't do this, though, because the fiberglass edges can rub on the skin and cause irritation. Call your child's doctor to have the problem fixed right away.

Why aren't some types of broken bones put in casts right away?
Some kinds of fractures don't need casts to heal. Certain fractures of larger long bones, such as the femur (thighbone), are hard to keep straight in a cast. Although doctors used to commonly put many of these kinds of fractures in traction (a way of gently pulling the bone straight), these days, surgery is often used instead.

Do all broken bones need casts?
It's not practical to cast ribs and collarbones (clavicles). Even displaced collarbones (in which pieces on either side of the break are out of line) heal well with a sling or special strap called a "figure-of-eight clavicle strap," which the child wears like a vest. Some non-displaced finger and toe fractures (in which the pieces on either side of the break line up) that don't involve the joint or the growing part of a child's bone (called the growth plate) may heal well with a splint or buddy taping (taping the injured digit to the adjacent unaffected finger or toe).

Will my child feel pain when the broken bone is in a cast?
Some pain is expected for the first few days, but it's usually not severe. Your child's doctor may recommend acetaminophen or ibuprofen to ease your child's pain.

How are casts taken off?
The doctor will use a small electrical saw to remove the cast. Although it may look and sound scary to your child, the process is actually quick and painless. The saw's blade isn't sharp - it has a dull, round blade that vibrates up and down. The vibration is strong enough to break apart the fiberglass or plaster, but shouldn't hurt your child's skin and may even tickle.

What will the injured area look and feel like when the cast is removed?
Once the cast is off, the injured area will probably look and feel pretty weird to your child: The skin will be pale, dry, or flaky; hair will look darker; and the area (muscles especially) will look smaller or weaker. Don't worry, though - this is all temporary. And depending on the type and location of your child's fracture, the doctor may also give your child special exercises to do to get the muscles around the broken bone back in working order.

Source: http://www.kidshealth.org/parent/firstaid_safe/emergencies/cast_faq.html

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Cast Care

Why do I need a cast?
You have been given a cast to help your broken bone or torn ligaments heal. A cast can help keep the injured area from moving so you can heal faster without risk of repeated injury. How long you'll need to wear your cast depends on the type of injury you have and how serious it is. Your doctor may want to check your cast 1 to 3 days after putting it on to be sure that the cast isn't too tight and that your broken bone or torn ligament is starting to heal.

Will the broken bone hurt?
Almost all broken bones cause pain. The cast should relieve some pain by limiting your movements. Your pain should become less severe each day. Call your doctor immediately if the pain in the casted area gets worse after the cast has been applied. New pain may mean that the cast is too tight. You should also call your doctor right away if you have new pain that develops in another area (for example, pain in your fingers or forearm if you have a wrist or thumb injury, or pain in your toes or calf if you have an ankle or foot injury).

To relieve discomfort that can occur when you get a cast, raise the cast above your heart by propping your arm or leg on pillows. You will have to lay down if the cast is on your leg. This may reduce pain and swelling. Your doctor may want to see you to check the cast.

Is it okay to get the cast wet?
With some fiberglass casts, you can swim and bathe. However, most casts shouldn't get wet. If you get one of these casts wet, irritation and infection of the skin could develop. Talk to your doctor about how to care for your cast.

To avoid getting the cast wet during bathing, you can put a plastic bag over the cast and hold it with a rubber band. If the cast does get wet, you may be able to dry out the inside padding with a blow-dryer. (Use a low setting and blow the air through the outside of the cast.) Ask your doctor about using a blow-dryer before trying this.

What can I do about itching?
If your skin itches underneath the cast, don't slip anything inside the cast, since it may damage your skin and you could get an infection. Instead, try tapping the cast or blowing air from a blow-dryer down into the cast.

Source: http://familydoctor.org/online/famdocen/home/healthy/firstaid/after-injury/094.html

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Speeding Up The Healing Process

Healing a broken bone takes time, and many patients don't want to be patient! Healing a broken bone is a process related to factors including patient age, overall health, nutrition, blood flow to the bone, and treatment.

1. Stop Smoking:
Some of these recommendations may be controversial, or unknown the extent to which they affect bone healing. However, this much is clear. Patients who smoke, have a much longer average time to healing, and a much higher risk of developing a nonunion (non-healing of the bone). Smoking alters the blood flow to bone, and it is that blood flow that delivers the necessary nutrients and cells to allow the bone to heal.

2. Eat a Balanced Diet:
Healing of bone requires more nutrients that the body needs to simply maintain bone health. Patients with injuries should eat a balanced diet, and ensure adequate nutritional intake of all food groups.

3. Watch Your Calcium:
Patients with broken bones tend to focus on this one, and I place it below balanced diet, because the focus should be on all nutrients. It's true that calcium is needed to heal bones, but taking excessive doses of calcium will not help you heal faster.

Ensure you are consuming the recommended dose of calcium, and if not, try to consume more natural calcium -- or consider a supplement. Taking mega-doses of calcium does not help a bone heal faster.

4. Adhere to Your Treatment Plan:
Your doctor will recommend a treatment, and you should adhere to this. Your doctor may recommend treatments including cast, surgery, crutches, or others. Altering the treatment ahead of scedule may delay your recovery. By removing a cast or walking on a broken bone before your doctor allows, you may be delaying your healing time.

5. Ask Your Doctor:
There are some fractures that may have treatment alternatives. For example, "Jones" fractures of the foot are a conroversial treatment area. Studies have shown these fractures usually heal with immobilization in a cast and crutches. However, many doctors will offer surgery for these fractures because patients tend to heal much faster.

Surgery creates potential risks, so these options much be weighed carefully. However, there may be options which alter the time it takes for a bone to heal.

6. Augmenting Fracture Healing:
Most often, external devices are not too helpful in accelerating fracture healing. The following devices have not been shown to accelerate the healing of most fractures. However, in difficult situations, these may be helpful to aid in healing of broken bones:

* Electrical Stimulation
* Ultrasound Treatment
* Magnets

Full article: http://orthopedics.about.com/od/castsfracturetreatments/ht/quickly.htm

What Does the Doctor Do?

To treat the broken bone, the doctor needs to know which kind of fracture it is. That's where X-rays come in handy. X-rays give the doctor a map of the fracture so that he or she can set the bones back in their normal position.

With breaks in larger bones or when a bone breaks in more than two pieces, the doctor may need to put in a metal pin - or pins - to help set it. For this operation, you'll get some medicine so you'll be asleep and unable to feel any pain. When your bone has healed, the doctor will remove the pin or pins.

After your bone has been set, the next step is usually putting on a cast, the special bandage that will keep the bone in place for the 1 to 2 months it will take for the break to mend. Casts are made of bandages soaked in plaster, which harden to a tough shell (that's why they last so long!).

Sometimes casts are made of fiberglass or plastic - and some are even waterproof, which means you can still go swimming and get them wet! And sometimes they come in cool colors or patterns that you can choose.

Source: http://www.kidshealth.org/kid/ill_injure/aches/broken_bones.html

Orthopedic cast - From Wikipedia, the free encyclopedia

A cast is a shell, frequently made from plaster, encasing a limb (or, in some cases, large portions of the body) to hold a broken bone (or bones) in place until it has healed.

Plaster bandages consist of a cotton bandage that has been impregnated with plaster of paris, which hardens after it has been made wet. Plaster of Paris is calcined Gypsum, ground to a fine powder by milling. When water is added, the more soluble form of calcium sulphate returns to the relatively insoluble form, and heat is produced.

2(CaSO4.½ H2O) + 3H2O -> 2(CaSO4.2H2O) + Heat[1]

The setting of unmodified plaster starts about 10 minutes after mixing and is complete in about 45 minutes, the cast is not fully dry though for 72 hours.[2]

Nowadays fiberglass bandages are often used. These consist of a knitted fiberglass bandage impregnated with polyurethane. These are lighter and dry much faster than plaster bandages. However, plaster can be more easily moulded to make a snug and therefore more comfortable fit. In addition, plaster is much smoother and does not snag clothing or abrade the skin. Plaster casts are generally made available only to patients who insist on them, because they take more time to apply, or when the cost of the fiberglass material is a consideration.

Full article: http://en.wikipedia.org/wiki/Orthopedic_cast