Patient information: Cast care

CAST CARE OVERVIEW

You have been fitted with a cast or splint to protect your bone and reduce pain as you heal. It is important to take care of your cast or splint to minimize the risk of potential complications, such as skin infection. If you have questions or concerns about your cast, contact your healthcare provider.

CAST CARE INSTRUCTIONS

• Mild swelling of the injured area is common during the first few days. Swelling may make your cast feel tight initially. To reduce swelling, keep the cast above the level of your heart for 24 to 48 hours. This can be accomplished by resting it on pillows. Also, gently move your fingers or toes (where the cast is located) frequently.
• Ice helps keep the swelling down. Apply a bag of ice (or a bag of frozen vegetables) covered with a thin towel to the cast for 20 minutes every two hours while awake. Do not apply ice directly to the skin.
• Take your pain medicine if you have pain. After the first few days, you may be able to take a non-prescription pain medication, such as ibuprofen (Advil, Motrin) or acetaminophen (Tylenol and others). Dosing instructions for these medications are available here. For adults, (table 1). For children, (table 2 and table 3).
• Do not get the cast or splint wet. To bathe with a cast, cover the cast with a plastic bag, tape the opening shut, and hang the cast outside the tub. Even when covered with plastic, you should not place the cast in water or allow water to run over the area. Waterproof cast covers are available at medical supply stores, but are not completely waterproof.
• If the cast becomes wet, you can dry it with a hair dryer on the cool setting. Do not use the warm or hot setting because this can burn the skin. You can also use a vacuum cleaner with a hose attachment to pull air through the cast and speed drying.
• Keep the cast clean and avoid getting dirt or sand inside the cast. Do not apply powder or lotion on or near the cast. Cover the cast when eating.
• Do not place anything inside the cast, even for itchy areas. Sticking items inside the cast can injure the skin and lead to infection. Using a hair dryer on the cool setting may help soothe itching.
• Do not pull the padding out from inside your cast.

WHEN TO SEEK HELP

• If there are sore areas or a foul odor from the cast, cracks or breaks in the cast, or the cast feels too tight.
• You develop swelling that causes pain or makes it so you cannot move your fingers or toes.
• You develop tingling or numbness in the arm or fingers or toes.
• Your fingers or toes are blue or cold.
• You develop severe pain in or near the casted arm or leg.
• The cast becomes soaking wet and does not dry with a hair dryer or vacuum.

WHERE TO GET MORE INFORMATION

Your healthcare provider is the best source of information for questions and concerns related to your medical problem. Because no two people are exactly alike and recommendations can vary from one person to another, it is important to seek guidance from a provider who is familiar with your individual situation.

This discussion will be updated as needed every four months on our web site (www.uptodate.com/patients). Additional topics as well as selected discussions written for healthcare professionals are also available for those who would like more detailed information.

Some of the most pertinent include:

Patient Level Information:

Professional Level Information:
Capitate fractures
Distal radius fractures in adults
Elbow anatomy and radiographic diagnosis of elbow fracture in children
Evaluation and management of supracondylar fractures in children
Fibular fractures
First (thumb) metacarpal fractures
General principles of fracture management: Fracture patterns and description in children
Hamate fractures
Lunate fractures
Metacarpal base fractures
Metacarpal head fractures
Metacarpal neck fractures
Metacarpal shaft fractures
Metatarsal shaft fractures
Midshaft humeral fractures in children
Orthopedic aspects of child abuse
Overview of ankle fractures
Overview of carpal fractures
Overview of metacarpal fractures
Overview of stress fractures
Overview of the causes of limp in children
Overview of tibial fractures
Patella fractures
Pisiform fractures
Proximal fifth metatarsal fractures
Proximal humeral fractures in children
Proximal tibial fractures
Scaphoid fractures
Sesamoid fractures of the foot
Splinting of musculoskeletal injuries
Stress fractures of the humeral shaft
Stress fractures of the metatarsal shaft
Stress fractures of the tibia and fibula
Tibial shaft fractures
Toe fractures
Trapezium fractures
Trapezoid fractures
Triquetral fractures

A number of web sites have information about medical problems and treatments, although it can be difficult to know which sites are reputable. Information provided by the National Institutes of Health, national medical societies and some other well-established organizations are often reliable sources of information, although the frequency with which they are updated is variable.

• American Academy of Orthopedic Surgeons

      (http://orthoinfo.aaos.org/topic.cfm?topic=a00095)

• KidsHealth

      (http://kidshealth.org/parent/firstaid_safe/emergencies/cast_faq.html)

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