Casts and Splints

Casts, splints and braces are devices that are placed around a limb to give it support. Casts and splints are generally not removable, while braces can be taken off. There are a variety of types of these that are used in different circumstances.

About Casts and Splints
A splint is a rigid support that does not encircle the limb. While it immobilizes the limb, it will expand to allow for swelling that may occur after a fracture or surgery. Generally the rigid part is made of Plaster of Paris or Fiberglass, and a soft wrap will hold it in place.

A cast is a special type of splint that completely encircles the limb. Casts are more rigid than splints, and because they encircle the limb they do not allow for any swelling. Casts are used for longer-term immobilization, but are not put on until the swelling in the limb has stabilized.

Casts and splints are made with Fiberglass or Plaster of Paris. These materials are activated by dipping them in water. As they initially harden they give off heat, and will be warm. They are also heavy and damp. It takes about one day for the water to evaporate out of the cast or splint. As it dries out, the cast or splint will become lighter.

Fractures
If you have had a fracture and have been referred from an emergency room, they will have place some type of brace or splint on the limb. Braces and splints are designed to immobilize the fractures The ends of the broken bones are very sensitive after a fracture, and any motion of them is painful. Using braces or splints will significantly improve the pain you have after a fracture.

Some fractures can be treated with a cast. The cast holds the bone together for the time required for the ends to knit. This is usually 4 – 6 weeks.

Surgery
If you have had surgery on your ankle, foot or leg you may have been placed in a cast or splint to immobilize the limb. There are many reasons to immobilize the limb depending on the type of surgery you had.

Care of Casts and Splints
Casts and splints generally need to be kept clean and dry. If you want to take a shower or bath when you have a cast or splint on, you should wrap the limb carefully with a plastic bag. Be careful, because all plastic bags can leak. If a plaster cast or splint gets wet, it will soften and may loosen. This will not happen to a fiberglass cast – surfboards are made of this material. However, if water gets under the cast against your skin it can cause problems for your skin. So, if your cast or splint gets significantly wet, it should be changed.

I have recently been using a new type of cast padding called Delta-Dry.  Casts made with this material can get wet, and will dry-out without causing problems with your skin.  This will allow you to take a bath or shower with no need to cover the cast.  You could also get into a swimming pool. If you would like to have your cast made with this material, let me know when it is time to apply it.  I will probably not be able to bill your insurance company for this material, so you may be asked to pay an additional fee of $20 to cover my material costs.

If you have an itch do not stick anything under the cast, as it may scratch your skin and could lead to an infection. Try using a hair dryer to blow air into the cast if it is really bothersome. Do not pick the padding out from under the cast. Do not cut the edges of the plaster or fiberglass. If an edge feels sharp, cover it with white adhesive tape or Dr. Scholl’s moleskin.

Cast and Splint Removal
Splints are simple to remove with bandage scissors. We simply find the area that is not covered by fiberglass or plaster of Paris, and cut the soft dressing with scissors.

Fiberglass and plaster casts are removed using a cast saw. This is a very special type of saw. The blade does not go around and around like a saw that is used to cut lumber. Instead, it oscillates back and forth. Because of this, material that is hard like a cast will be cut by the rough blade. Conversely, soft materials like skin are pushed away as this blade rubs back and forth. It is really very difficult to cut your skin using the cast saw. I will demonstrate that for you when I remove your cast. Most patients still feel nervous having casts removed, because the visual effect combined with the vibration from the saw makes it seem as though the blade can cut you. You will probably feel nervous about this until the cast finally comes off and you see that there has been no damage to your skin.

Cast Problems
If there is a problem with the cast and it needs to be removed please call my office. You will be fit into the office schedule that day, if you call early, or the next day if your call is late. If you can not wait to come into the office, go to the nearest emergency room where your situation will be assessed by the emergency room physicians. I will be contacted, or the on-call physician will be contacted.

Please do not remove your cast or splint yourself. It may be dangerous to do that, as you may cut yourself in the process. The cast or splint has been applied to hold a certain position of the limb, and when the support has been removed that may disrupt an underlying fracture or surgical area.

More Information

3M has more information about casts, cast care and cast removal in a PDF file that can be viewed here