When to Call Your Doctor

Check the cast and the skin around the edges of the cast everyday. Look for any damage to the cast, or any red or sore areas on the skin.

Call the doctor immediately if any of the following happen:

The cast gets wet, damaged, or breaks.

Skin or nails on the fingers or toes below the cast become discolored, such as blue or gray.

Skin, fingers, or toes below the cast are numb, tingling, or cold.

The swelling is more than before the cast was put on.

Bleeding, drainage, or bad smells come from the cast.

Severe or new pain occurs.

Source: http://www.emedicinehealth.com/cast_care/page8_em.htm

Complications

Many potential complications are related not only to wearing a cast but also to the healing of the underlying fracture.

Immediate complications

- Compartment syndrome

Compartment syndrome is a very serious complication that can happen because of a tight cast or a rigid cast that restricts severe swelling.

Compartment syndrome happens when pressure builds within a closed space that cannot be released. This elevated pressure can cause damage to the structures inside that closed space or compartment—in this case, the muscles, nerves, blood vessels, and other tissues under the cast.

This syndrome can cause permanent and irreversible damage if it is not discovered and corrected in time.

Signs of compartment syndrome

Severe pain
Numbness or tingling
Cold, pale, or blue-colored skin
Difficulty moving the joint or fingers and toes below the affected area.

If any of these symptoms occur, call the doctor right away. The cast may need to be loosened or replaced.

A pressure sore or cast sore can develop on the skin under the cast from excessive pressure by a cast that is too tight or poorly fitted.

Delayed complications

- Healing problems


Malunion: The fracture may heal incorrectly and leave a deformity in the bone at the site of the break. (Union is the term used to describe the healing of a fracture.)

Nonunion: The edges of the broken bone may not come together and heal properly.

Delayed union: The fracture may take longer to heal than is usual or expected for a particular type of fracture.

Children are at risk for a growth disturbance if their fracture goes through a growth plate. The bone may not grow evenly, causing a deformity, or it may not grow any further, causing one limb to be shorter than the other.

Arthritis may eventually result from fractures that involve a joint. This happens because joint surfaces are covered by cartilage, which does not heal as easily or as well as bone. Cartilage may also be permanently damaged at the time of the original injury.

Source: http://www.emedicinehealth.com/cast_care/page7_em.htm

How a Cast Is Removed

Do not try to remove the cast.

When it is time to remove the cast, the doctor will take it off with a cast saw and a special tool.

A cast saw is a specialized saw made just for taking off casts. It has a flat and rounded metal blade that has teeth and vibrates back and forth at a high rate of speed.

The cast saw is made to vibrate and cut through the cast but not to cut the skin underneath.

After several cuts are made in the cast (usually along either side), it is then spread and opened with a special tool to lift the cast off.

The underlying layers of cast padding and stockinette are then cut off with scissors.

After a cast is removed, depending on how long the cast has been on, the underlying body part may look different than the other uninjured side.

The skin may be pale or a different shade.

The pattern and length of hair growth may also be different.

The injured part may even look smaller or thinner than the other side because some of the muscles have weakened and have not been used since the cast was put on.

If the cast was over a joint, the joint is likely to be stiff. It will take some time and patience before the joint regains its full range of motion.

Source: http://www.emedicinehealth.com/cast_care/page6_em.htm

How Casts Are Applied

Many different sizes and shapes of casts are available depending on what body part needs to be protected. A doctor decides which type and shape is best for each person.

Cast application

Before casting material is applied (plaster or fiberglass), a "stockinette" is usually placed on the skin where the cast begins and ends (at the hand and near the elbow for a wrist cast). This stockinette protects the skin from the casting material.

After the stockinette is placed, soft cotton batting material (also called cast padding or Webril) is rolled on. This cotton batting layer provides both additional padding to protect the skin and elastic pressure to the fracture to aid in healing.

Next, the plaster or fiberglass cast material is rolled on while it is still wet.

The cast will usually begin to feel hard about 10-15 minutes after it is put on, but it takes much longer to be fully dry and hard.

Be especially careful with the cast for the first 1-2 days because it can easily crack or break while it is drying and hardening. It can take up to 24-48 hours for the cast to completely harden.

Plaster casts

A plaster cast is made from rolls or pieces of dry muslin that have starch or dextrose and calcium sulfate added.

When the plaster gets wet, a chemical reaction happens (between the water and the calcium sulfate) that produces heat and eventually causes the plaster to set, or get hard, when it dries.

A person can usually feel the cast getting warm on the skin from this chemical reaction as it sets.

The temperature of the water used to wet the plaster affects the rate at which the cast sets. When colder water is used, it takes longer for the plaster to set, and a smaller amount of heat is produced from the chemical reaction.

Plaster casts are usually smooth and white.

Fiberglass casts

Fiberglass casts are also applied starting from a roll that gets wet.

After the roll gets wet, it is rolled on to form the cast. Fiberglass casts also get warm and harden as they dry.

Fiberglass casts are rough on the outside and look like a weave when they dry. Some fiberglass casts may even be colored.

Source: http://www.emedicinehealth.com/cast_care/page3_em.htm