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Cast Types and Maintenance Instructions

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Orthopedics offers comprehensive care for children suffering from injuries and conditions that affect the musculoskeletal system, including bone fractures.Children’s Health℠ orthopedic department treats more children with bone fractures than any other medical center in the Dallas/Fort Worth region. 

A fracture is a partial or complete break in a bone. It occurs when more force is applied to a bone than it can absorb. Your child could suffer a bone break from a fall or trauma, or as a result of a direct blow to the body. A bone break can be an open fracture (also called a compound fracture), where the bone is visible through the skin, or it can be a closed (or simple) fracture where the skin remains intact.

If your child suffers a fracture, a physician will apply a cast to foster the healing of the broken bone. A cast will hold the broken bone in place. Casts also help prevent or decrease muscle contractions and are effective at immobilizing the area of the break, especially after surgery.

Cast Composition and Types

Cast Composition and Types

The outside – the hard part of the cast – is made from two kinds of material: plaster or fiberglass. The lining of the cast is made from cotton or from synthetic materials.

Casts fall into two primary types, with a few options for each:

  • Upper extremity casts
  • Short arm cast
  • Long arm cast
  • Arm cylinder cast
  • Lower extremity casts
  • Short leg cast
  • Long leg cast
  • Leg cylinder cast

Casts also can be used to immobilize the trunk of the body and one or more limbs. These are called spica casts. Each serves a specific purpose – for instance, to hold the hip muscles and tendons in place after surgery to allow for proper healing – and they offer several options:

  • Unilateral hip spica cast (applied from the chest to the foot on one leg for thigh fractures)
  • One-and one-half hip spica cast (applied from the chest to the foot on one leg to the knee of the other leg)
  • Bilateral long leg hip spica cast (applied from the chest to the feet)
  • Short leg hip spica cast (applied from the chest to the thighs or knees)
  • Shoulder spica cast (applied around the trunk of the body to the shoulder, arm and hand)

One other type, a Minerva cast, is applied around the neck and trunk of the body after surgery on the neck or upper back area.

Treatment

Treatment

If your child suffers a fracture, a physician will apply a cast to foster the healing of the broken bone.

A fracture is a partial or complete break in a bone. It occurs when more force is applied to a bone than it can absorb. You child could suffer a bone break from a fall or trauma, or as a result of a direct blow to the body. A bone break can be an open fracture (also called a compound fracture), where the bone is visible through the skin, or it can be a closed (or simple) fracture where the skin remains intact.

A cast will hold the broken bone in place. Casts also help prevent or decrease muscle contractions and are effective at immobilizing the area of the break, especially after surgery.

Types

Cast types fall into two primary types: upper extremity and lower extremity. Different casts include:

  • Short arm cast – applied below the elbow to the hand for forearm or wrist fractures or to hold the forearm or wrist muscles and tendons in place after surgery
  • Long arm cast – applied from the upper arm to the hand for upper arm, elbow or forearm fractures or 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
  • Shoulder spica cast – applied around the trunk of the body to the shoulder, arm and hand for 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 for lower leg fractures, severe ankle sprains/strains or fractures, and to hold the leg or foot muscles and tendons in place after surgery to allow healing
  • Leg cylinder cast – applied from the upper thigh to the ankle for knee or lower leg fractures, knee dislocations, or after surgery on the leg or knee area
  • Unilateral hip spica cast – applied from the chest to the foot on one leg for thigh fractures and 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. It is used for thigh fractures or 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. It is used for pelvis, hip or thigh fractures or to hold the hip or thigh muscles and tendons in place after surgery to allow healing.
  • 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
  • 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. It is used to hold the hip muscles and tendons in place after surgery to allow healing.

 

Maintenance

Maintenance

As a parent, you’ll need to oversee the care of the cast to avoid re-injury, discomfort or infection. This means

  • Keeping your child’s cast clean and dry
  • Checking for cracks or breaks in the cast
  • Refraining from putting powders or lotions inside the cast
  • Covering the cast while your child is eating (to prevent spills and crumbs from entering the cast)
  • Encouraging your child to move his or her fingers or toes to promote circulation
  • Discouraging your child from inserting objects under the cast to scratch the skin

If itchiness becomes a problem, you can use a hair dryer placed on a cool setting to blow air under the cast and cool down the hot, itchy skin. If your child is in a body cast, you may need to provide him or her with a bedpan or portable urinal.

Here are some other care tips:

  • Rough edges of the cast can be padded to protect the skin from scratches.
  • Elevate the cast above the level of the heart to decrease swelling.
  • Do not use the abduction bar on the cast to lift or carry the child.
  • Keep body casts clean and dry to prevent skin irritation around the genital area.

Often, your child will be given assistive devices while his body area is immobilized. These include:

  • Crutches
  • Walkers
  • Wagons
  • Wheelchairs
  • Reclining wheelchairs

Problems with casts sometimes arise. These may need the intervention of a physician. Call your doctor if you see that your child has a fever greater than 101° F (38.3° C) or is suffering increased pain. Other red flags include

  • 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

For assistance, call Children’s Health Orthopedic Department at 214-456-7697.

Resources

Resources

  • After the Injury.org - Geared toward pediatrics, this website provides instructions on how to care for your child’s cast.
  • eMedicineHealth - This site provides visitors with information about cast types and maintenance, fracture types and healing, and helpful glossaries.
  • Medline Plus - This site provides information about fractures and casts for patients and their families.
FAQs

FAQs

Why does my child need a cast?

If your child suffers a fracture, a physician will apply a cast to foster the healing of the broken bone. A cast will hold the broken bone in place. Casts also help prevent or decrease muscle contractions and are effective at immobilizing the area of the fracture, especially after surgery.

What causes a fracture?

A fracture – a partial or complete break in the bone – occurs when there is more force applied to the bone than the bone can absorb. Breaks in bones can result from falls, trauma or a direct blow to the body. Bones are weakest when they are twisted.

A bone break can be an open fracture (also called a compound fracture) where the bone is visible through the skin, or it can be a closed (or simple) fracture where the skin is not broken.

Are there differences in fractures in children compared with fractures in an adult?

No. The same forces that cause bone breaks in adults cause bone breaks in children. However, children’s bones are softer than those of adults and tend to buckle or bend rather than completely break. Also, a child’s bone heals much faster than an adult’s bone. The younger the child, the faster the healing occurs.

But the long-term impact of fractures can be more complex for children, as they have open growth plates (epiphysis) at the end of their long bones. This is an area where the bone grows. Injury to the growth plate can lead to limb-length discrepancies or angular deformities.

Are there different types of fractures?

Common types of fractures that occur in children include

  • Greenstick – an incomplete fracture, where a portion of the bone is broken, causing the other side to bend
  • Transverse – when the break is in a straight line across the bone
  • Spiral – when the break spirals around the bone (common in a twisting injury)
  • Oblique – a diagonal break across the bone
  • Compression – when the bone is crushed, causing the broken bone to be wider or flatter in appearance
  • Comminuted – when the break is in three or more pieces

If your child suffers a fracture, a physician will apply a cast to help the broken bone heal.

What does a cast do?

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.

Cast types fall in two primary types: upper extremity and lower extremity. Upper extremity casts include the short arm and long arm casts and the arm cylinder cast. Lower extremity casts include the short leg cast, the long leg cast and the leg cylinder cast.

What are casts made of?

The outside, or hard part of cast, is made from two kinds of materials: plaster or fiberglass. Cotton and other synthetic materials line the inside of cast, making it soft and providing padding around bony areas, such as the wrist or elbow. Waterproof cast liners may be used under a fiberglass cast, allowing the child to get the cast wet.

How can my child move around while in a cast?

A cast is designed to restrict mobility but, depending on the nature of the fracture, your child can move around in a cast, thanks to assistive devices such as crutches, walkers, wagons and wheelchairs.

How can I help my child while he or she is in a cast?

As a parent, you’ll need to oversee the care of the cast to avoid re-injury, discomfort or infection. This means keeping the cast clean and dry, checking for cracks or breaks in the cast, refraining from putting powders or lotions inside the cast, covering the cast while your child is eating (to prevent spills and crumbs from entering the cast), encouraging your child to move his or her fingers or toes to promote circulation and discouraging your child from inserting objects under the cast to scratch the skin. If itchiness becomes a problem, you can use a hairdryer placed on a cool setting to blow air under the cast and cool down the hot, itchy skin. If your child is in a body cast, you may need to provide him or her with a bedpan or portable urinal.

Follow these tips for preventing infection or discomfort for a child in a body cast:

  • Keep the genital area as clean and dry as possible to prevent skin irritation.
  • 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.

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