Orthopedic Casts

What is cast?
 holds a broken bone in place as it
heals
 help to prevent or decrease muscle
contraction, and are effective at
providing immobilization, especially
after surgery
What are cast are made of?
2 Different Kinds Casting Materials:

Plaster – white in color

- consist of a cotton bandage
that has been impregnated
Fiberglass – comes in a variety of
colors, patterns, and designs
Limitations of Plaster Cast
the skin under the plaster becomes dry
and scaly because the
discarded outer skin cells are not washed
or brushed off
plaster of Paris casts can result in
cutaneous complications including
macerations, ulcerations, infections,
rashes, itching, burns, and allergic contact
dermatitis, which may also be due to the
presence of formaldehyde within the
their weight, which can be quite
considerable, thus restricting
movement, especially of a child
plaster of Paris casts break down if
patients get them wet
 Fiberglass Casts
1970s – development of fiberglass
casts
More lighter and durable
1990s – introduction of new casts
lining
completely waterproof, allowing
patients to bathe, shower, and swim
while wearing a cast
 What are the different types of casts?
Type of Cast Location Uses
Short arm cast: Applied below the elbow Forearm or wrist
to the hand. fractures. Also used to
hold the forearm or wrist
muscles and tendons in
place after surgery.
Long arm cast: Applied from the upper Upper arm, elbow, or
arm to the hand. forearm fractures. Also
used to hold the arm or
elbow muscles and
tendons in place after
surgery.
Arm cylinder cast: Applied from the upper To hold the elbow
arm to the wrist. muscles and tendons in
place after a dislocation or
surgery.
Type of Cast Location Uses
Shoulder spica cast: Applied around the trunk Shoulder dislocations or
of the body to the after surgery on the
shoulder, arm, and hand. shoulder area.
Minerva cast: Applied around the neck After surgery on the neck
and trunk of the body. or upper back area.

Short leg cast: Applied to the area below Lower leg fractures, severe
the knee to the foot. ankle sprains/strains, or
fractures. Also used to
hold the leg or foot
muscles and tendons in
place after surgery to allow
healing.

Leg cylinder cast: Applied from the upper Knee, or lower leg
thigh to the ankle. fractures, knee
dislocations, or after
surgery on the leg or knee
area.
Type of Cast Location Uses
Unilateral hip spica cast: Applied from the chest Thigh fractures. Also used
to the foot on one leg. to hold the hip or thigh
muscles and tendons in
place after surgery to
allow healing.
One and one-half hip Applied from the chest Thigh fracture. Also used
spica cast: to the foot on one leg to to hold the hip or thigh
the knee of the other muscles and tendons in
leg. A bar is placed place after surgery to
between both legs to allow healing.
keep the hips and legs
immobilized.
Bilateral long leg hip Applied from the chest Pelvis, hip, or thigh
spica cast: to the feet. A bar is fractures. Also used to
placed between both hold the hip or thigh
legs to keep the hips and muscles and tendons in
legs immobilized. place after surgery to
allow healing.
Type of Cast Location
Short leg hip spica cast: Applied from the chest
to the thighs or knees.
Type of Cast Location
Abduction boot cast: Applied from the upper
thighs to the feet. A bar
is placed between both
legs to keep the hips
and legs immobilized.
Uses
To hold the hip muscles
and tendons in place
after surgery to allow
healing.
Uses
To hold the hip
muscles and tendons
in place after surgery
to allow healing.
Assistive devices for children with
casts include:
crutches
walkers
wagons
wheelchairs
reclining wheelchairs
Cast Care Instructions:
Keep the cast clean and dry.
Check for cracks or breaks in the
cast.
Rough edges can be padded to
protect the skin from scratches.
Do not scratch the skin under the
cast by inserting objects inside the
cast.
Can use a hairdryer placed on a cool
setting to blow air under the cast and cool
down the hot, itchy skin. Never blow warm
or hot air into the cast.
Do not put powders or lotion inside the
cast.
Cover the cast while your child is eating to
prevent food spills and crumbs from
entering the cast.
Prevent small toys or objects from being
put inside the cast.
Elevate the cast above the level of
the heart to decrease swelling.
Encourage your child to move his/her
fingers or toes to promote circulation.
Do not use the abduction bar on the
cast to lift or carry the child.
Procedure: Short Arm Cast
The stockinette with a hole for the thumb
is slipped over fingers, hand, forearm and
elbow. It should exceed the ends of the
cast by 5cm at least. To set the bones a
suspension with a weight of 2-3kg on the
upper arm is used.
Then a cotton wool bandage is wrapped, which
should exceed the ends by 5cm at least.
Particularly the area of the wrist should be
padded well. After that, paper bandages are
applied to compress the padding.
A longuette with a hole for the
thumb is put on the inner side
of forearm and hand. If fibreglass
is used the longuette is dispensable.
Now one casting bandage follows.
It is important that the line of
knuckles is not squeezed.
After the suspension is removed
corrections of the cast could be made.
Finally the padding is fold down at the
thumb and both ends of the cast. It is
secured under the last layer of casting
bandages.
If swellings could occur the
cast should be split on one side
and an elastic bandage be
wrapped round.
Procedure: Short Arm Cast w/ Thumb
The application is similar to a
short arm cast. But here, an
extra stockinette for the thumb
is needed. Further, the longuette is cut and the
smaller stripe surrounds the thumb.
The hand should be fixed in
a position in which the tips of
thumb and forefinger can reach each other.
Procedure: Forearm Splint
Wounds will be covered by compresses.
The padding, if necessary, is applied in
accordance with the short arm cast. A
plaster longuette covered by a stockinette
is used as splint. It can be put on the inner
(volar) or the outer side (dorsal) of the
hand
If one puts the plaster splint directly on the
skin without padding, the set and dried
material should be covered with another
stockinette. Finally, elastic bandages are
wrapped round the splint
Procedure: Forearm splint with Thumb
The procedure is similar to the forearm splint. The
splint can be put on the inner (volar) or the outer side
(dorsal) of the hand. It depends on the position of the
wound.

Padding is here essential. Furthermore, one puts

gauze strips between the included fingers. To control
circulation and sensibility, the fingertips should not
be covered with bandages.
Procedure: Long Arm Cast
One starts with the stockinette which reaches the
shoulder. After setting the bones align cotton wool
and paper bandages are applied. The first casting
bandage follows.

If plaster is used a longuette is put on the outer side

of the arm.
Further casting bandages follow. Finally,
the padding is fold down at both ends of
the cast and is secured under the last layer.
Procedure: Short leg cast
During the application the patient should lie face
downwards and the lower leg is in a vertical position
(see figures). The stockinette exceeds knee and
toes. Cotton wool and paper bandages to compress
the wool follow. Achilles tendon and places where
bones are located immediately under the skin should
be padded well.
If plaster is used one applies a first circular
layer. It is dispensable if no pressure is put
on the cast.
Then a L-like longuette is prepared,
that lies on the back of the lower leg and
on the sole of the foot. If a walking cast is
made a further longuette is put on the sole.

Another circular layer follows. Finally, the

padding is fold down at both ends of the cast and
is secured under the last layer. A further bandage
can fix a walking sole to the cast.
If fibreglass is used only one longuette is
put onto the first layer of bandages on the
sole. Two layers follow.
Procedure: Cylinder Cast
The stockinette is pulled over the whole leg.
Cotton wool and paper bandages follow.
Especially the part above the ankle, where
compression could occur, also the knee and the
cast border at the thigh should be padded well.
Only in the case of plaster, two longuettes are
put on the outer sides of the leg. After cast
bandages were applied, padding and stockinette
are folded down and secured with another
bandage. The cast could slip if the parts above
the ankle and around the knee are not prepared
well.
Procedure : Long Leg
The knee should rest in an angle of 155-170°.
Pains occur after a period of time in a 180°
position. In the case of plaster the padding and
the first layer is followed by an U-like longuette. It
lies on the sides of the leg and runs round the
heel. In the case of fibreglass this longuette is
unnecessary.
In both cases after the second layer a
longuette is put on the sole that exceeds
the toes (toe plate). The third, and after
folding down padding and stockinette, the
fourth layer of casting bandages follow. In
the case of plaster a fifth layer is needed
usually.
Thank You!!!