A cast is a rigid dressing applied to an injured limb to hold it in a specific position. Its primary purpose is to provide complete immobilization of a fractured bone or damaged joint. By stabilizing the bone fragments, the cast facilitates fracture healing and ensures the bone mends with the correct anatomical alignment.
Initial Care Locations for Fractures
Initial care location depends on the injury’s severity and time of day. The Emergency Room (ER) is reserved for severe cases, such as an open fracture, significant trauma, excessive bleeding, or loss of consciousness. The ER is also necessary for injuries outside of normal business hours, ensuring immediate stabilization.
For suspected simple fractures, sprains, or minor breaks without severe deformity or open wounds, an orthopedic urgent care clinic is often the ideal first step. These facilities specialize in musculoskeletal injuries, offering on-site imaging and immediate treatment, often bypassing the lengthy wait times and higher costs of the ER. General urgent care centers provide initial assessment and X-rays, but usually apply a temporary splint and refer the patient to an orthopedic specialist for definitive casting.
The ultimate application of a cast and long-term fracture management are typically handled by an orthopedic specialist or their clinic. Even if the initial injury is seen in an ER or general urgent care, the patient is often directed to the orthopedic clinic for follow-up, especially for complex or displaced fractures. These specialty clinics manage the entire process, from re-evaluation to final cast removal.
The Diagnosis and Casting Procedure
Once the patient arrives, the medical process begins with a physical assessment and imaging to confirm the injury. A physician performs a focused exam to check for pain, swelling, and deformity, followed by ordering X-rays to visualize the bone structure. X-ray images are essential for determining the precise location, type, and severity of the fracture.
If X-rays show that the broken bone fragments are significantly misaligned, closed reduction is necessary before the cast is applied. This non-surgical process involves the physician manually manipulating the limb to realign the bone segments into their correct anatomical position. The reduction is often performed under local anesthesia or sedation to minimize pain and muscle spasm.
Cast application involves several protective layers. First, a soft stockinette is placed directly over the skin of the injured limb. A layer of cotton or synthetic padding is then rolled over the stockinette to cushion bony prominences and protect the skin. The outer layer is created using a casting material, typically fiberglass, which is lighter, more durable, and dries faster than traditional plaster. The wet casting material is wrapped around the padding and held in position until it hardens, providing final, rigid immobilization.
Essential Post-Casting Management
Proper care of the cast and limb is necessary once the patient is at home to prevent complications and ensure successful bone healing. The affected limb should be elevated above the level of the heart as frequently as possible during the first 48 to 72 hours to reduce swelling that can lead to tightness and discomfort. Monitoring for signs of circulatory or nerve impairment is required, including checking for excessive pain not relieved by elevation, numbness, tingling, or a change in the color of the fingers or toes.
The cast must be kept clean and completely dry to prevent skin irritation, breakdown, and potential infection. Patients should avoid submerging the cast in water during bathing and can use waterproof covers for showering. To manage itching, a cool-setting hairdryer can blow air inside, but never insert any object inside the cast to scratch an itch, as this can damage the skin and lead to a serious infection.
Scheduled follow-up appointments are necessary, usually within one to two weeks, to allow the specialist to check the cast fit and take new X-rays. This confirms the bone fragments have remained properly aligned as initial swelling subsides. The full duration of casting is typically six to eight weeks, depending on the fracture type and location, and a final X-ray is performed before the cast is removed with a specialized oscillating saw.