Cast Care
Plaster: 24-48 hours to dry (handle with palms, not fingers). Fiberglass: dries in 1-2 hours. Elevate above heart for first 48h. Assess cast for tightness, cracks, soft spots. Petal edges if rough. Do not get wet (unless waterproof). Neurovascular checks q1-2h for first 24h, then q4h.
Complications
Compartment syndrome: pain out of proportion, with passive stretch, paresthesia, pallor, pulselessness (late). Pressure necrosis: burning pain under cast. Infection: fever, odor, drainage. Thermal injury: from plaster drying. Embolism: fat embolism syndrome (long bone fractures — petechial rash, respiratory distress, mental status changes).
Patient Education
Keep cast dry (plastic bag for bathing). Do not insert anything inside cast (hangers, rulers). Elevate above heart for swelling. Report: burning, numbness, tingling, increased pain, odor, drainage, fever. Do not walk on cast unless specifically ordered. Follow-up appointments for cast check.
Important Notes
- Compartment syndrome: pain out of proportion, especially with passive stretching — bivalve cast immediately, emergency fasciotomy if not relieved.
- Never insert anything inside a cast to scratch — can cause skin breakdown and infection.
Clinical Tips
- Handle wet plaster casts with palms, not fingers — finger dents cause pressure points.
- Fat embolism syndrome: petechial rash (chest, axilla), respiratory distress, mental status changes — emergency.
Summary
Cast care requires neurovascular checks, monitoring for compartment syndrome, keeping the cast dry, and educating patients on warning signs.
