Orthopedic cast

An orange short arm cast with a fiberglass top layer being cut and removed with a specialized cast
saw.

An orthopedic cast, body cast or surgical cast, is a shell, frequently made from plaster, encasing a
limb (or, in some cases, large portions of the body) to hold a broken bone (or bones) in place until
healing is confirmed. It is similar in function to a splint.

Plaster bandages consist of a cotton bandage that has been impregnated with plaster of paris, which
hardens after it has been made wet. Plaster of Paris is calcined Gypsum, ground to a fine powder by
milling. When water is added, the more soluble form of calcium sulfate returns to the relatively
insoluble form, and heat is produced.

2 (CaSO4·½ H2O) + 3 H2O → 2 (CaSO4.2H2O) + Heat[1]

The setting of unmodified plaster starts about 10 minutes after mixing and is complete in about 45
minutes; the cast is not fully dry though for 72 hours.[2]

Nowadays bandages of synthetic materials are often used, often knitted fiberglass bandages
impregnated with polyurethane, sometimes bandages of thermoplastic. These are lighter and dry
much faster than plaster bandages. However, plaster can be more easily moulded to make a snug and
therefore more comfortable fit. In addition, plaster is much smoother and does not snag clothing or
abrade the skin. Plaster casts are generally made available only to patients who insist on them,
because they take more time to apply, or when the cost of the fiberglass material is

Limitations of plaster casts

Due to the nature of the dressing in that the limb is unreachable during treatment; the skin under the
plaster becomes dry and scaly because the discarded outer skin cells are not washed or brushed off.
Also, plaster of Paris casts can result in cutaneous complications including macerations, ulcerations,
infections, rashes, itching, burns, and allergic contact dermatitis, which may also be due to the
presence of formaldehyde within the plaster bandages. In hot weather, staphylococcal infection of the
hair follicles and sweat glands can lead to severe and painful dermatitis.

Other limitations of plaster casts include their weight, which can be quite considerable, thus restricting
movement, especially of a child. Removal of the cast requires destroying the cast itself. The process is
often noisy, making use of a special oscillating saw that can cut the hard cast material but not soft
material like cast padding or skin. Although the removal is painless, this can be distressing for the
patient, especially children. Additionally, plaster of Paris casts break down if patients get them wet.

fibreglass and polyurethane casting material,

4ply

Cotton and plaster casting material,(plaster cast) 4 ply.

Due to the limitations of plaster of Paris surgeons have also experimented with other types of
materials for use as splints. An early plastic like material was Gutta-Percha obtained from the latex of
trees found in Malaya. It resembled rubber, but contained more resins. When dry it was hard and
inelastic, but when warmed it became soft and malleable. In 1851 Utterhoeven, described the use of
splints made from this material for the treatment of fractures. In the 1970s, the development of
fibreglass casting tape made it possible to produce a cast that was lighter and more durable than the
traditional plaster cast and also resistant to water (although the bandages underneath were not)
allowing the patient to be more active.

In 1990s the introduction of new cast lining has meant that fiberglass casts with this liner are
completely waterproof, allowing patients to bathe, shower, and swim while wearing a cast. The
waterproof cast liner however adds approximately 2 to 3 more minutes to the application time of the
cast and increases the cost of the cast.[4] Drying time, however, can be inconvenient enough to
warrant a cast and bandage moisture protector. These waterproof covers allow for bathing and
showering while wearing either a plaster or fiberglass cast. The waterproof cast cover stays tightly
around your cast and prevents water from ever reaching it while you are in contact with water. You
simply remove it and let it dry once done and it can be re-used often.

[edit] Cast types

Upper extremity casts

Left Arm cast from a wrist injury

Upper extremity casts are those which encase the arm, wrist, and/or hand. A long arm cast
encases the arm from the hand to about 2 inches below the arm pit, leaving the fingers and thumbs
free. A short arm cast, in contrast, stops just below the elbow. Both varieties may, depending on the
injury and the doctor's decision, include one or more fingers or the thumb, in which case it is called a
finger spica or thumb spica cast.

[edit] Lower extremity casts

Newly applied short leg cast

Lower extremity casts are classified similarly, with a cast encasing both the foot and the leg to the
hip being called a long leg cast, while a cast encasing the patients foot, ankle and lower leg ending
below the knee is referred to as a short leg cast. A walking heel may be applied for ambulation.
Similarly, a cast shoe/cast boot/cast sandal may be provided to the patient to be utilized during
ambulation of the immobilized limb during convalescence (referred to as being weight bearing).
Additionally, a castshoe may be used to simply protect the patients casted foot while helping to
maintain a higher degree of hygiene preventing the cast from directly contacting potentially dirty or
wet ground surfaces. Where the patient is not to walk on the injured limb, crutches or a wheelchair
may be provided. The foots under-sole portion of the of a leg cast may be extended terminating at tip
of the patients toes, to create a rigid support which limits motion of the metatarsals in both weight
bearing and non-weight bearing leg casts. These are referred to toeplates in the orthopedic discipline
of medicine. This addition may be applied to further support and stabilize the metatarsals by limiting
motion through a higher degree of immobilization, as well as protecting the toes from additional blunt
force trauma. Typically leg casts which incorporate a toeplate are prescribed for injuries to the foot
and metatarsals. Ordinarily, a leg cast applied for the treatment of a stable ankle fracture would not
utilize the toeplate design because there is no need to immobilize and limit the motion of the patient's
toes.

[edit] Cylinder cast

In some cases, a cast may include the upper and lower arm and the elbow, but leaves the wrist and
hand free, or the upper and lower leg and the knee, leaving the foot and ankle free. Such a cast may
be called a cylinder cast, or may simply be called a long arm or long leg cast.

[edit] Body casts

Body casts, which cover the trunk of the body, and in some cases the neck up to or including the
head (see Minerva Cast, below) or one or more limbs, are rarely used today, and are most commonly
used in the cases of small children, who cannot be trusted to comply with a brace, or in cases of
radical surgery to repair an injury or other defect. A body cast which encases the trunk (with "straps"
over the shoulders) is usually referred to as a body jacket.

[edit] Spica cast

A cast which includes the trunk of the body and one or more limbs is called a spica cast, just as a cast
which includes the "trunk" of the arm and one or more fingers or the thumb is. For example, a
shoulder spica includes the trunk of the body and one arm, usually to the wrist or hand. Shoulder
spicas are almost never seen today, having been replaced with specialized splints and slings which
allow early mobility of the injury so as to avoid joint stiffness after healing.

A hip spica includes the trunk of the body and one or more legs. A hip spica which covers only one
leg to the ankle or foot may be referred to as a single hip spica, while one which covers both legs is
called a double hip spica. A one-and-a-half hip spica encases one leg to the ankle or foot and the
other to just above the knee. The extent to which the hip spica covers the trunk depends greatly on
the injury and the surgeon; the spica may extend only to the navel, allowing mobility of the spine and
the possibility of walking with the aid of crutches, or may extend to the rib cage or even to the
armpits in some rare cases. Hip spicas were formerly common in reducing femoral fractures, but today
are rarely used except for congenital hip dislocations, and then mostly while the child is still an infant.

In some cases, a hip spica may only extend down one or more legs to above the knee. Such casts,
called pantaloon casts, are occasionally seen to immobilize an injured lumbar spine or pelvis, in
which case the trunk portion of the cast usually extends to the armpits.

[edit] Other casts

Other body casts which were used in decades past to protect an injured spine or as part of the
treatment for a spinal deformity (see scoliosis) which are rarely seen today include the Minerva cast
and Risser cast. The Minerva cast includes the trunk of the body (sometimes extending down only so
far as the rib cage) as well as the patient's head, with openings provided for the patient's face, ears,
and usually the top of the head and hair. The Risser cast was similar, extending from the patient's
hips to the neck and sometimes including part of the head. Both of these casts could, with care and
the doctor's permission, be walked in during convalescence. However, in some cases the Risser cast
would extend into one or more pantaloons, in which case mobility was far more restricted.

Aside from the above common forms, body casts could come in nearly any size and configuration. For
example, from the 1910s to the 1970s, use of a turnbuckle cast, which used metal turnbuckles to
twist two halves of the cast so as to forcibly straighten the spine before surgery, was common. The
turnbuckle cast had no single configuration, and could be as small as a body jacket split in half, or
could include the head, one or both legs to the knees or feet, and/or one arm to the elbow or wrist
depending on the choice of the doctor.

Despite the large size and extreme immobilization some casts, particularly those used in or before the
1970s, the popular term full body cast is something of a misnomer. The popular and media-driven
conception of a massive cast encasing all four limbs, the trunk, and the head - sometimes leaving only
small slits for the eyes, nose, and mouth - is a true rarity in recorded medical history, and this type of
large scale cast appears more commonly in various Hollywood movies and on television shows. The
term body cast (or full body cast) is sometimes casually used by laymen to describe any of a number
of body and/or spica casts, from a simple body jacket to a more extensive hip spica.