Professional Documents
Culture Documents
College of Nursing
Hatem Alsrour
Why Do We Splint?
• Abrasions
• Sores
• Neurovascular compromise (tight fitting
splints)
• Contact dermatitis
• Pressure ulcers
• Thermal burns
How to prevent complications
• Apply splint by trained
professional
• Airplane Cast
Humerous and shoulder joint with
compound fracture
Basket Cast
Severe leg trauma with open
wound or inflammatin
Body Cast
Lower dorso-lumbar spine
affection
Boot Leg Cast
Hip and femoral fracture
Cast Brace
Fracture of the femur (distal
curve) with flexion and extension
Collar Cast
Cervical affection
Cylindrical Leg Cast
Fractured patella
Double Hip Spica Mold
Cervical affection with callus
formation
Frog Cast
Congenital hip dislocation
Functional Cast
Fractured humerous with
abduction and adduction
Hanging Cast
Fractured shaft of the humerous
Internal Rotator Splint
post hip operation
Long Arm Circular Cast
Fractured radius and ulna
How Casts Are Applied
• Cast application
– Before casting material is applied (plaster or fiberglass), a "stockinette" is usually placed on the skin
where the cast begins and ends (at the hand and near the elbow for a wrist cast). This stockinette protects
the skin from the casting material.
– After the stockinette is placed, soft cotton batting material (also called cast padding or Webril) is rolled
on. This cotton batting layer provides both additional padding to protect the skin and elastic pressure to
the fracture to aid in healing.
– Next, the plaster or fiberglass cast material is rolled on while it is still wet.
– The cast will usually begin to feel hard about 10-15 minutes after it is put on, but it takes much longer to
be fully dry and hard.
– Be especially careful with the cast for the first 1-2 days because it can easily crack or break while it is
drying and hardening. It can take up to 24-48 hours for the cast to completely harden.
• Plaster casts
– A plaster cast is made from rolls or pieces of dry muslin that have starch or dextrose and calcium sulfate
added.
– When the plaster gets wet, a chemical reaction happens (between the water and the calcium sulfate) that
produces heat and eventually causes the plaster to set, or get hard, when it dries.
– A person can usually feel the cast getting warm on the skin from this chemical reaction as it sets.
.
– Plaster casts are usually smooth and white.
• Fiberglass casts
– Fiberglass casts are also applied starting from a roll that gets wet.
– After the roll gets wet, it is rolled on to form the cast. Fiberglass casts also get warm and harden as they
dry.
• Fiberglass casts are rough on the outside and look like a weave when they dry. Some
fiberglass casts may even be colored
Nursing Care
• Handle wet cast with palms of the hands, not the fingers. Doing
so may cause flattering or indentions in the cast that might
cause pressure problems.
• Cast should be allowed to air dry.
• Elevate the cast on one to two pillows during drying.
• Observe ‘hot spot” and musty color. These are signs and
symptoms of infection.
• Maintain skin integrity.
• Do neurovascular checks:
– Skin color
– Skin temperature
– Sensation
– Mobility
– Pulse
• Assess for vascular occlusion
• Adhesive tape petals reduce irritation at cast edges.
Cast Care Instruction
• 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.
Ice and Elevation
• A doctor may want the person to use ice to help decrease
the swelling of the injured body part. (Check with a
physician before using ice.)
• To keep the cast from becoming wet, put ice inside a
sealed plastic bag and place a towel between the cast and
the bag of ice.
• Apply ice to the injury for 15 minutes each hour (while
awake) for the first 24-48 hours.
• Try to keep the cast and injured body part elevated above
the level of the heart, especially for the first 48 hours after
the injury occurs.
• Elevation will help to decrease the swelling and pain at the
site of the injury.
• Propping the cast up on several pillows may be necessary
to help elevate the injured area, especially while asleep.
How a Cast Is Removed
• Do not try to remove the cast.
• When it is time to remove the cast, the doctor will take it off with a cast saw and a
special tool.
– A cast saw is a specialized saw made just for taking off casts. It has a flat and rounded metal
blade that has teeth and vibrates back and forth at a high rate of speed.
– The cast saw is made to vibrate and cut through the cast but not to cut the skin underneath.
– After several cuts are made in the cast (usually along either side), it is then spread and
opened with a special tool to lift the cast off.
– The underlying layers of cast padding and stockinette are then cut off with scissors.
• After a cast is removed, depending on how long the cast has been on, the underlying
body part may look different than the other uninjured side.
– The skin may be pale or a different shade.
– The pattern and length of hair growth may also be different.
– The injured part may even look smaller or thinner than the other side because some of the
muscles have weakened and have not been used since the cast was put on.
• If the cast was over a joint, the joint is likely to be stiff. It will take some time and
patience before the joint regains its full range of motion.
Complications
• Many potential complications are related not only to wearing a cast but also to
the healing of the underlying fracture.
• Immediate complications
• Compartment syndrome
– Compartment syndrome is a very serious complication that can happen because of
a tight cast or a rigid cast that restricts severe swelling.
– Compartment syndrome happens when pressure builds within a closed space that
cannot be released. This elevated pressure can cause damage to the structures
inside that closed space or compartment—in this case, the muscles, nerves, blood
vessels, and other tissues under the cast.
– This syndrome can cause permanent and irreversible damage if it is not discovered
and corrected in time.
– Signs of compartment syndrome
• Severe pain
• Numbness or tingling
• Cold, pale, or blue-colored skin
• Difficulty moving the joint or fingers and toes below the affected area.
– If any of these symptoms occur, call the doctor right away. The cast may need to be loosened
or replaced.
• A pressure sore or cast sore can develop on the skin under the cast from excessive pressure by a
cast that is too tight or poorly fitted.
When to Call Your Doctor
• Check the cast and the skin around the edges of the
cast everyday. Look for any damage to the cast, or
any red or sore areas on the skin.
• Call the doctor immediately if any of the following
happen:
– The cast gets wet, damaged, or breaks.
– Skin or nails on the fingers or toes below the cast become
discolored, such as blue or gray.
– Skin, fingers, or toes below the cast are numb, tingling, or
cold.
– The swelling is more than before the cast was put on.
– Bleeding, drainage, or bad smells come from the cast.
• Severe or new pain occurs
Thank you