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Cast Care (cont.)

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 atrophied or weakened because they 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 rehabilitation and some time and patience before the joint regains its full range of motion.

Cast 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 and fingers or toes below the affected area.
  • If any of these symptoms occur, call the doctor or go to the emergency department immediately. 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.

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.

Medically reviewed by John A. Daller, MD; American Board of Surgery with subspecialty certification in surgical critical care

REFERENCES:

1. Amendola A, Twaddle B. Compartment syndromes. In: Browner BD, Jupiter JB, Levine AM, Trafton PG, eds. Skeletal Trauma. 2nd ed. Philadelphia, Pa:WB Saunders Co;1998:365-389.

2. Latta L, Sarmiento A, Zych G. Principles of nonoperative fracture treatment. In: Browner BD, Jupiter JB, Levine AM, Trafton PG, eds. Skeletal Trauma. 2nd ed. Philadelphia, Pa:WB Saunders Co;1998:237-266.

3. Rosen P, Barkin RM, eds. Emergency Medicine: Concepts and Clinical Practice. 4th ed. St. Louis, Mo:Mosby-Year Book;1998:620-622.

4. Salter RB. Fractures and joint injuries. In: Textbook of Disorders and Injuries of the Musculoskeletal System. 2nd ed. Baltimore, Md:Lippincott Williams & Wilkins;1983:349-426.

5. Simon R, Koenigsknecht S. Fracture principles. In: Emergency Orthopedics: The Extremities. 3rd ed. Norwalk, Conn:Appleton & Lange;1996:3-20, 517-36.

6. Simon RR, Koenigsknecht SJ. Treatment of fractures. In: Emergency Orthopedics: The Extremities. 2nd ed. Norwalk, Conn:Appleton & Lange;1987:7-15.

7. Tintinalli JE, Menkes JS. Immobilization techniques. In: Tintinalli JE, Kelen GD, eds. Emergency Medicine: A Comprehensive Study Guide. 5th ed. New York, NY:McGraw-Hill;2000:1747-1753.


Medically Reviewed by a Doctor on 6/2/2016
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