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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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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How to tell a broken bone from a hole in the snow

Winter is definitely here, with snow and ice in the morning, followed by sun and puddles in the afternoon. This can often cause a fall. Falling forward is a very common injury from many outside activities -- including skiing, snowboarding or running on icy trails -- and usually results in nothing more than a bruise or a bump.

Most commonly, falls mean a fracture of the wrist or hand, but sometimes the force of the blow can be transferred up the arm to the elbow. In this case, there could be a fracture or dislocation of the bones of the elbow, and the radial head is often where this occurs.

There are two bones in the forearm that connect to one in the upper arm. The humerus is the bone that goes from the shoulder to the elbow. At the elbow, it widens out so that it can connect to the bones of the forearm (the radius and the ulna). The construction of the forearm is complex in that it must allow rotation of the forearm so the wrist can go from facing down to facing up while still providing stability. This is achieved by having each bone swap functions at each end of the forearm. In the elbow, the radius is the bone that rotates. In the wrist, the ulna is the one that allows rotation. It is a pretty neat construct.

If there are excess loads to the forearm or wrist, these stresses can literally be sent up the arm to the elbow. This can result in so much force on the elbow and the forearm bones that something has to give. What gives depends upon many things, but one of the most important is that age of the person.

Young children tend to dislocate the elbow or fracture the end of the humerus or upper arm bone. Older people tend to fracture the wrist since they tend to have less calcium and weaker bones. Between the ages of 30 and 40, more commonly in women, the part of the radius bone that connects with the elbow is where the fracture occurs.

If you are unlucky enough to have an injury like this, here are some of the signs that you should look for:

Pain in and around the elbow, especially on the outside of the elbow.

Swelling around the elbow, especially on the outside.

Pain with bending or straightening the elbow.

Pain with trying to turn the forearm, such as with turning the palm up and down.

Pain in the elbow, especially on the outside, when gripping.

If any of these symptoms are present, you should get the arm in a sling or a splint to protect it and get it checked out. In most cases, the diagnosis is made from a routine X-ray, and we can classify the break as either a type I, II or III fracture depending on the severity.

If the initial X-rays are negative and the pain and especially loss of motion persist, you might need an MRI. This will allow proper treatment and hopefully a rapid return to full activity.

Paul Collins, M.D., is an orthopedic surgeon specializing in sports medicine at Orthopedic Health Care in Boise, Idaho. Collins is an avid participant in many outdoor activities.

Source: http://dailycamera.com/news/2007/dec/20/the-elbow-fractures-connected-to-the/

Muscle over fat

I suppose it is no different today than at any time in our nation's history, but why is only bad news considered to be news? Why can't we get daily updates about the success stories from our soldiers in Iraq? Why don't we get hourly news reports reinforcing our nation's farm products as wholesome and necessary?

I am not quite sure other than I realize that we, as humans, just aren't wired to relate to good news as well as that with a hint of a scare. If you are in need of a scare today, you might as well quit reading now. From this point forward, this column is reporting only good news that you otherwise probably wouldn't hear much about; so if you like it, tell all of your friends and neighbors.

"Milk does the body good" has been proven in a whole new sense at McMaster University in Hamilton, Ontario, Canada. Researchers compared the effects of drinking nonfat milk, a soy protein drink or a carbohydrate drink on muscle building and fat burning after subjects completed weight lifting workouts. The research was done by Stuart M. Phillips, Ph.D., associate professor of kinesiology and an exercise physiologist. The results have been published in the Aug. 1, 2007 issue of the American Journal of Clinical Nutrition.

Phillips and his colleagues recruited 56 healthy young men, average age 22, and assigned them to drink milk, a soy drink or a carbohydrate drink immediately after their weight training exercises and then one hour later. The milk and soy drinks were matched for protein, fat, and carb content. Each had 18 grams of protein, 1.5 grams of fat and 23 grams of carbohydrates.

Participants weight-trained five days a week for 12 weeks, and all the participants were novices. They had not done any weight training for the past eight months. The exercises were done on standard weight training machines, which worked out all the major muscle groups, with participants increasing repetitions as they gained strength.

The milk drinkers gained the most muscle. "The gains of muscle in the milk group were 8.8 pounds, vs. 6 pounds for the soy group, vs. 5.3 pounds for the control group (drinking the carbohydrate drink)," says Phillips. "The group that drank the milk gained 60 percent more muscle than the carbohydrate group and 40 percent more than the soy group," Phillips says.

Those who drank milk also had more strength gains than the other two groups in two kinds of individual exercises: knee extensions and hamstring curls.

The milk drinkers also lost more body fat. "They lost almost 2 pounds of body fat," he says. "The soy group barely changed, in terms of body fat. It was about a third of a pound. In the control group (the carbohydrate drinkers) it was about a pound of body fat lost.

Experts have responded to these results indicating that they are not really sure why the milk protein is beneficial, but think that the calcium may allow your body to burn more fat. Interestingly enough--as our nation attempts to figure out why so many of our youths are overweight--could it be that we are overlooking some simple reasons: too much couch time, poor drink choices and not enough milk?

The National Institute of Health indicates that fewer than one in 10 girls and just one in four boys ages 9 through 13 are getting enough calcium. Some experts call osteoporosis a juvenile disease because poor bone mass in adulthood often begins in adolescence. Soda and sports drinks not only take the place of milk, but they also tie up calcium and vitamin D so that they are not available for use by the growing body. This results in tooth decay and an increased likelihood of broken bones.

During growth spurts, it is essential that growing children get enough calcium to supply their bones with needed nutrients. In fact, 90 percent of a person's peak bone mass for adulthood is established by the late teen years. The strength and health of an adult's bones largely depends on calcium intake during formative years.

Yet, we have seen a trend of kids drinking less milk every year. Activists have been trying to get milk and dairy products out of our kid's diets. And the results of this study confirm what farm families have known all along: Milk and dairy products are an essential part of your daily diet, no matter how old you are. Of course, naysayers have overlooked the fact that the first food substance we are provided at birth is milk. Would our maker have started us off on the wrong foot? We need to get back to a basic diet that includes milk, meat, fresh fruits and vegetables--and good, old-fashioned hard work--and we can make a big dent in the obesity problem in this country.

Source: http://www.hpj.com/archives/2007/aug07/aug27/Muscleoverfat.cfm

Lazy children risk broken bones

Children who do not take enough exercise are in danger of suffering broken bones in later life, according to a study.

Many are failing to build up their skeleton during a vital two-year window before puberty, which is critical to building healthy bones.

Researchers in Canada have found children have the greatest increase in bone mineral after the growth spurt just before puberty.

In girls this tends to be between 10 and 12 and in boys it is from 13 to 15.

Extra effort to exercise during this time can make a big difference, say researchers at the University of British Columbia in Vancouver, who are studying 383 children.

Research co-ordinator Heather McKay said: "If we can increase bone mass by 10% by adulthood, we can decrease the incidence of fractures by 50%."

The young volunteers took part in a circuit training programme lasting 10 minutes just three times a week.

Children in this group have to skip and do box jumps, side-to-side jumps and other high-impact exercises.

Other children spend the same amount of time doing stretches and warm ups.

After a year, the girls doing circuit training had amassed an extra 2% of bone mineral compared with the stretchers.

After two years they were ahead by 5%, it is reported in New Scientist.

'Banking' bones

The results on boys are still being analysed.

People lose a quarter of their bone mass as they age.

Whether this weakens our bones largely depends on how much we build them up in childhood.

Experts believe changes need to be made to the way physical education is taught in schools.

The National Osteoporosis Society (NOS) believes these findings need to be taken on board by parents and children.

A spokesman said: "The NOS is concerned about the type of physical activity that children are getting, often with too little emphasis being put into weight bearing exercises such as running, skipping and jumping.

"The NOS would like every child to get the right level of physical activity and put "bone in the bank" for later in life.

"Many children need to be more physically active and one of the ways of tackling the huge problem of osteoporosis is to encourage youngsters to increase peak bone mass by taking enough of the right type of exercise with a well-balanced calcium rich diet."

Source: http://news.bbc.co.uk/1/hi/health/1751664.stm