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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What Should You Do When the Cast Comes Off?

Can you believe they use a saw to remove your cast? The funny thing is this saw doesn't hurt your skin at all. It might even tickle! Once the cast is off, the injured area will probably look and feel pretty weird. The body part that was in a cast might look strange at first. The skin might be pale, dry, or flaky. Body hair might look darker and the body part itself might look smaller because you might have lost some muscle while it was healing.

Don't worry. This is all temporary. Kids are great healers, so you'll be back to normal soon. In some cases, your doctor might suggest you do special exercises to improve your strength and flexibility. You'll want to go slow and ask the doctor if there are any activities you should avoid, such as hanging from the monkey bars. If you want to return to a sport, ask the doctor how soon you'll be able to do it.

How can you be sure you don't break any more bones? Accidents happen, but you often can prevent injuries by wearing safety helmets, pads, and the right protective gear for your activity or sport.

It's also a smart idea to do what you can to build strong bones. How do you do that?

Get a lot of physical activity, especially stuff like jumping and running.
Feed your bones the calcium and vitamin D they need to stay strong. That means getting your share of milk and other calcium-rich foods and drinks, such as broccoli and calcium-fortified orange juice.

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

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Caring For A Cast

There are 2 types of casts that may be used to mend a broken (fractured) bone.

Plaster of Paris Cast

It takes about 2-3 days for plaster to dry after the cast has been put on. While your cast is drying, handle it with care. Rest your cast on soft surfaces only, or use a pillow. Do not rest your cast on the floor, table or desk. Do not walk on a walking cast until it is dry!

Water or moisture will cause your cast to break down, become soft or crack. Once it is wet, it will not harden again! A cast that is soft or cracked may not hold the bone(s) in place and may need to be replaced or reinforced.

Fiberglass Cast

The fiberglass cast is lighter and tougher than plaster. Do not get your cast wet. The fiberglass repels water on the outside of the cast but the padding on the inside is the same as in the plaster cast. If it gets wet, the skin under it can blister and break down. If the outside of the cast becomes dirty, use a damp cloth and mild soap to clean it.

Rest your limb on a pillow. To prevent the heel and other areas from developing sores under the cast (if you have a leg cast), it is important to rest your cast on a pillow, with the heel hanging freely over the edge. Support should be the same along the length of the limb with the cast - not at just one spot.

For all new fractures of any limb it is important to raise the limb above the heart for the first 2-3 days whenever possible. This will help to decrease pain and swelling.

Raise your limb if at any time you notice that your toes or fingers :

* are more swollen
* are a bluish colour
* feel numb or tingle (pins and needles)

Normal colour and feeling should return after a short period of time (at least 20 minutes). If this does not help, call your healthcare provider. Wiggling your fingers or toes now and then while in a cast is important. It helps stimulate blood flow and can help decrease the swelling. If there is increasing pain with moving the fingers or toes the cast may be too tight and need to be opened. In this case, go to the Emergency Department.

Bruising is normal, even if the bruising is not in the same area as your fracture. When a bone breaks, it bleeds. The blood may go down your limb by gravity. For example, if you break your arm you may notice that your hand is bruised.

Crutches or Sling

If you have been asked to use crutches or a sling, please do so. If you have been told not to walk on your cast, do not. The doctor often tells you not to walk on your cast because the break (fracture) is not stable. This means the bones could move out of alignment and you could need an operation to set it back into position.

Bathing in a Cast

Bathing in both types of casts is a challenge. You should not shower, as it is hard to control any water dripping into the cast.

Keep the Cast Protected

Use supplies from home:

1. Cover it with a towel (use elastic bands to hold it in place).
2. Cover the whole limb with a plastic bag.
3. Seal the upper edge with tape (can be duct tape but watch for skin irritation).

Buy new supplies:
A bath sleeve to cover casts may be purchased at a medical supply store. (Not recommended as it does not fit children well).

No matter what you use to protect the cast, remember to keep the limb/cast out of the water. Neither method allows the cast to be put in water.

Care for Your Cast

Do not modify (change) your cast in any way. If you remove padding or cut away pieces of your cast the position of the bones could change. The padding is there to protect your skin when the cast is being removed.

Do Not Put Anything Into Your Cast

Any object placed into your cast can irritate or create a sore inside the cast.

Casts are now padded with a material that has greatly improved the problem of itchiness. This padding helps repel moisture such as perspiration (sweat) and also allows better flow of air to the skin. If you have an itch under your cast, use a hair dryer on a cool setting to blow air down your cast. This often will stop the itch.

Contact the Doctor Looking After You or Go To the Emergency Department if You Have:

* An unusual or foul smell coming from within your cast
* A new stain on your cast caused by fluids that have collected from inside your cast
* A fever
* New pain that is in only one spot under your cast
* Noticed your toes and fingers are disappearing into your cast (the cast may be loose and the bones may shift)
* Numbness, tingling (pins and needles) or you cannot move your fingers or toes after you have raised the cast above your heart for at least 20 minutes

Disclaimer

Reviewed by Alberta clinical experts. Brought to you by HealthLink Alberta. Copyright

This material is designed for information purposes only. It should not be used in place of medical advice, instruction and/or treatment. If you have specific questions, please consult your doctor or appropriate health care professional.