Cast Types and
Maintenance Instructions
What is a cast?What is a cast?
• A cast holds a broken bone in place as it heals. Casts also help to prevent or decrease muscle contractions, and are effective at providing immobilization, especially after surgery.
• Casts immobilize the joint above and the joint below the area that is to be kept straight and without motion. For example, a child with a forearm fracture will have a long arm cast to immobilize the wrist and elbow joints.
What are casts made of?What are casts made of?
The outside, or hard part of the cast, is made from two different kinds of casting materials.
• plaster - white in color. • fiberglass - comes in a variety of colors, patterns, and
designs.
Cotton and other synthetic materials are used to line the inside of the cast to make it soft and to provide padding around bony areas, such as the wrist or elbow.
Special waterproof cast liners may be used under a fiberglass cast, allowing the child to get the cast wet. Consult your child's physician for special cast care instructions for this type of cast.
FUNCTIONSFUNCTIONS
• To promote healing and early weight bearing
• To support, maintain and protect realigned bone
• To prevent or correct deformity
• To immobilize
CONTRAINDICATIONS CONTRAINDICATIONS
• Pregnancy
• Skin disease
• Swelling / Edema
• Open wound
• Infection
NURSING CARE NURSING CARE
• Handle wet cast with palms of hands, not fingers
• Cast should be allowed to air dry
• Elevate cast on one to two pillows during drying
• Observe “hot spot” and musty odor. These are signs and symptoms of infection.
• Maintain skin integrity
• Do neurovascular checks: – Skin color – Skin temperature – Sensation – Mobility – Pulse
• Assess for vascular occlusions
• Adhesive tape petals reduce irritation and cast edges
• Prevent complications of immobility – Bedsores – Hypostatic pneumonia– Constipation – Renal calculi – Osteoporosis – Muscular atrophy
What are the different types of What are the different types of casts?casts?
Below is a description of the Below is a description of the various types of casts, the various types of casts, the location of the body they are location of the body they are applied, and their general applied, and their general function.function.
Type of Cast
Location Uses
Short arm cast:
Applied below the elbow to the hand.
Forearm or wrist fractures. Also used to hold the forearm or
wrist muscles and tendons in place after surgery.
Long arm cast:
Applied from the upper arm to the
hand.
Upper arm, elbow, or forearm fractures. Also used to hold the arm or elbow muscles and tendons in place after
surgery.
Arm cylinder
cast:
Applied from the upper arm to the
wrist.
To hold the elbow muscles and tendons in place after a dislocation or surgery.
Type of Cast
Location Uses
Shoulder spica cast:
Applied around the trunk of the body to the
shoulder, arm, and hand.
Shoulder dislocations or after surgery on the shoulder area.
Minerva cast:
Applied around the neck and trunk of the body.
After surgery on the neck or upper back area.
Short leg cast:
Applied to the area below the knee to the foot.
Lower leg fractures, severe ankle sprains/strains, or fractures. Also used to hold the leg or foot muscles and tendons in place after surgery to allow
healing.
Legcylinder
cast:
Applied from the upper thigh to the ankle.
Knee, or lower leg 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 to the foot on one leg.
Thigh fractures. Also used to hold the hip or thigh
muscles and tendons in place after surgery to
allow healing.
One and one-half hip
spica cast:
Applied from the chest to the foot on one leg to the knee
of the other leg. A bar is placed between both legs to
keep the hips and legs immobilized.
Thigh fracture. Also used to hold the hip or thigh
muscles and tendons in place after surgery to
allow healing.
Bilateral long
leg hip spica cast:
Applied from the chest to the feet. A bar is placed
between both legs to keep the hips and legs
immobilized.
Pelvis, hip, or thigh fractures. Also used to
hold the hip or thigh muscles and tendons in
place after surgery to allow healing.
Type of Cast
Location Uses
Short leg hip
spica cast:
Applied from the chest to the thighs or
knees.
To hold the hip muscles and tendons in place after surgery to allow
healing.
Type of Cast Location Uses
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.
To hold the hip muscles and tendons in place after surgery to
allow healing.
How can my child move around while in a cast?
• Assistive devices for children with casts include:
• crutches
• walkers
• wagons
• wheelchairs
• reclining wheelchairs
Cast care instructions: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.
Older children with body casts may need to use a bedpan or urinal in order to go to the bathroom.
Tips to keep body casts clean and dry and prevent skin irritation around the genital area include the following:
• Use a diaper or sanitary napkin around the genital area to prevent leakage or splashing of urine.
• Place toilet paper inside the bedpan to prevent urine from splashing onto the cast or bed.
• Keep the genital area as clean and dry as possible to prevent skin irritation.
When to call your child's When to call your child's physician:physician:
• fever greater than 101° F
• increased pain
• increased swelling above or below the cast
• complaints of numbness or tingling
• drainage or foul odor from the cast
• cool or cold fingers or toes
TRACTION TRACTION
• Is the act of pulling or drawing which is associated with counter traction. Traction means that a pulling force is applied to a part of the body or an extremity while a counter traction pulls in the opposite direction. In straight or running traction coutertraction is supplied by the patient’s body with the bed.
PURPOSESPURPOSES
• Prevent / correct deformity
• Relieve pain
• Relieve muscle spasm
• Reduce / immobilize fractures
PRINCIPLES PRINCIPLES
• Principles should be supine
• Avoid friction
• Allow the weights to hang freely
• Apply traction continuously
• There should be an adequate countertraction
• The line of pull should be in line with the deformity
TYPES TYPES
• Skin traction
• Skeletal traction
• Manual traction
NURSING CARE NURSING CARE
• Skin – Monitor for vascular occlusion– Maintain countertraction – Maintain weights hanging freely– Maintain positioning – Provide daily rewrapping – Detection of pressure points
• Skeletal – Inspection – Dressing – Traction apparatus (maintain alignment)– Skin care – Prevent complications of bed rest
• Muscles – Strengthening exercise for upper extremities – Strengthening exercise for lower extremities – Preparation for crutch walking
• Vascular occlusions (the five P’s)– Paralysis – Paresthesia – Pulselessness – Pallor – Pain