Precautions with Casting

A cast can't do its job without proper care. Find out the basics of cast care, from keeping a cast clean to knowing when to call the doctor.

What are the different types of casts?

Casts are applied to fit and support injured limbs. Casts are also applied to immobilize limbs and the spine after surgery.

Casts may also be applied in situations when there is no injury. For example, casts are used to correct deformities. At times casts are also applied to heal wounds.

There are two main types of cast materials:

• Plaster-of-Paris (POP) casts:- These are the standard white chalky material casts. These are used in most situations. These are especially useful for deformity correction. POP casts are easier to mold for some uses than are fiberglass casts. Plaster casts are generally less expensive.
• Fiberglass casts: - These plastic material casts are typically lighter and more durable than POP casts. Also, X-rays penetrate fiberglass casts better than plaster casts — making it easier for your doctor to examine your child's bones while he or she is still wearing the cast. These casts can only be removed by electric plaster cutting saws.

When a cast is applied, the main concern is the post injury swelling. In a cast, the swollen limb cannot swell more, and therefore internal pressure in the injured area can rise.

What can be done to reduce swelling?

Swelling can cause your child's cast to feel tight and uncomfortable. To reduce swelling:

• Elevate the affected area :- For the first 24 to 72 hours after your child's cast is applied, use pillows to raise the cast above the level of your child's heart ( with the child lying down). Your child will need to recline if the cast is on a leg.
• Apply ice :- Loosely wrap an ice pack covered in a thin towel around your child's cast at the level of the injury. Wrapping the ice is important to keep the cast dry. Ice that's packed in a rigid container and touches the cast at only one point won't be as effective.
• Keep moving :- Encourage your child to frequently move the fingers or toes of the injured limb.

What can I do if my child wants to scratch under the cast?

A cast can cause your child's underlying skin to feel itchy. To relieve itchy skin, turn a hair dryer on a cool setting and aim it under the cast.

Don't allow your child to stick objects, such as a pen, inside the cast to scratch his or her skin. This could cause an injury or infection.

Is it allright to get a cast wet?

That depends on the type of cast your child has.

In general, casts are meant to stay dry. A wet cast can lead to skin irritation or infection. Plaster casts and fiberglass casts with conventional padding are not waterproof. Keep your child's cast dry during baths or showers by covering it with two layers of plastic, sealed with a cotton string. Avoid swimming while wearing a cast that isn't waterproof.

A fiberglass cast that has a waterproof liner can get wet. Only certain types of breaks can be treated with a waterproof cast and liner. Ask your doctor if it's safe for your child to get his or her cast wet.

If the cast does get wet, you might be able to dry out the inside padding with a hair dryer. Use a NO heat or cold air setting to avoid burning or irritating the skin.

Babies and children can get a cast wet  - especially around the genitals. The cause is urine leaking into the cast. The liner gets soaked with urine. The cast develops an odour after repeated soaking. Soon a rash develops ( also called a diaper rash) and then an infection follows. 

It is therefore very important not to allow the cast to be soaked with urine. (Please see Hip Spica precautions). And dry immediately with a hair dryer kept on COLD setting. 

How can my child keep his or her cast in a good condition?

Try these tips:

• Keep it clean :- Keep dirt and sand away from the inside of your child's cast.
• Skip toiletries :- Avoid placing talcum powder, lotion or deodorant inside the cast.
• Leave adjustments to your child's doctor :- Don't pull the padding out of your child's cast. Don't trim the cast or break off rough edges without first asking the doctor.

What else do I need to know about my child's cast?

Contact your child's doctor immediately if your child:

• Feels increasing pain and tightness in the injured limb
• Feels numbness or tingling in the injured hand or foot
• Feels burning or stinging under the cast
• Develops excessive swelling below the cast
• Can't move the toes or fingers of his or her injured limb, or they become blue or cold
• Says the cast feels too tight or too loose
• Develops red or raw skin around the cast
• Develops a crack, soft spots or a foul odor in the cast, or gets the cast soaking wet and doesn't dry it properly

Caring for a child's cast isn't always easy. Remind your child that taking care of the cast will help minimize discomfort during the healing process.