Cast care

Casts are used to immobilize fractured bones and injured tendons or ligaments while they heal. Taking good care of your cast can promote healing and help prevent complications.


Types of casts
Casts are usually made from plaster or fiberglass. Plaster casts are less expensive, but they can take hours or even days to completely dry. Fiberglass casts, which set within about 30 minutes, weigh less and are more durable.
Arm and leg casts may cover the entire extremity or only part of it. Casts can also be designed to fit over the hips, larger sections of the body or even the entire body. Some casts allow you to bear weight on the affected area, while others don't.

Your doctor will determine which type of cast is best for you.


General cast care
For the first 24 to 48 hours, elevate the casted area above the level of your heart as much as possible to help prevent swelling. Don't put pressure on the cast until it's completely dry, which could take up to two days with a plaster cast.
To prevent skin irritation and infection, keep your cast and the underlying padding dry. When you bathe, use tape to secure plastic wrap, a plastic bag or a commercial wrap around the cast. If the cast gets wet, dry it with the low setting on a hair dyer. A damp cast may develop a sour smell.

If your doctor recommends a fiberglass cast, you may want to ask about a waterproof liner, which must be set in place before the cast is applied. The liner allows water to drain from under the cast, leaving you free to bathe or swim without worry about keeping the cast dry.

Every day, periodically elevate the casted area and wiggle your fingers or toes to promote circulation underneath the cast.

It's also important to examine your cast. Report any splits, cracks or breaks to your doctor. Until he or she is able to repair the damage, support the cast with adhesive tape or an elastic bandage. You may want to tape any rough edges as well.

How long the cast must be worn depends on the type of injury and how quickly it heals. Don't attempt to remove the cast yourself. Your doctor or other medical personnel will remove the cast with specialized equipment.

When the cast is removed, the affected area may appear thinner than it did before the injury because the muscles have grown weaker. As you resume normal activities, the muscles will build up again.


Comfort measures
To prevent swelling and ease pain or itching, apply an ice pack or waterproof baggie filled with ice directly to the cast. If the itching is intense, blow air from a hair dyer set on low into the cast. It may also help to tap on the cast.
Depending on the circumstances, your doctor may recommend an over-the-counter antihistamine, such as diphenhydramine (Benadryl, for example). Remember that some antihistamines can cause drowsiness. Follow the directions and any precautions printed on the label.

Don't use powders or lotions under the cast, and never scratch the itchy skin. Utensils such as coat hangers, back scratchers or pencils may cause breaks in the skin that could lead to an infection.

Notify your doctor if you notice possible signs of infection, such as:

a foul or musty odor coming from the cast
an increase in pain or swelling
a fever

Complications
Infection: Swelling or scratching the skin under the cast can lead to infection or tissue injury. This may also occur if a wet cast is dried improperly.

Compartment syndrome: If a cast is too tight or swelling beneath the cast increases the size of the extremity, you may develop a condition known as compartment syndrome. Dull pain beneath the cast may gradually intensify, the pain may be difficult to control with medication, or there may be significant pain when stretching the muscles in the affected area.

Other symptoms in the affected or nearby area may include:

lack of skin color
inability to move
weak or absent pulse
a sensation of pricking, tingling or creeping
skin that feels cold to the touch
Compartment syndrome is considered a medical emergency. Typically, the cast is loosened or removed to relieve the pressure. Left untreated, the pressure can cause limb deformity or permanent nerve or tissue damage.

Cast syndrome: If the duodenum (the first part of the small intestine) is compressed between the aorta (the body's largest artery) and the superior mesenteric artery (an artery connected to the aorta), a condition known as cast syndrome may develop. Symptoms, which may appear weeks or months after the cast was applied, may include:

abdominal pain, pressure or bloating
nausea
shortness of breath
Cast syndrome is a rare complication most often associated with body casts.


Pregnancy-specific information
Casts can be worn during pregnancy.

Senior-specific information
Casts can be worn by older adults.