Caring for Patients with Plaster Casts and Splints

Dr. Amitava Pal Choudhury PT (VP, South Zone)

When a person sustains a fracture or experiences a severe musculoskeletal injury, plaster casts and splints become essential tools in the recovery process. These medical devices provide stability and support to injured bones, allowing them to heal correctly. However, proper care and attention are crucial to ensure the patient’s comfort and the success of the treatment. In this comprehensive guide, we will delve into the various aspects of caring for patients with plaster casts and splints, from initial assessment to daily maintenance and potential complications.

Initial Assessment

The first step in caring for a patient with a plaster cast or splint is a thorough initial assessment. This involves examining the affected area, taking into account the type and location of the injury, and understanding the specific care requirements. Here are some key considerations:

• Medical History: Gather information about the patient’s medical history, allergies, and any previous injuries that may affect the current condition.
• X-rays and Diagnostic Tests: Review any X-rays or diagnostic tests to assess the extent of the injury and determine the appropriate type of cast or splint.
• Swelling and Circulation: Check for swelling, discoloration, and any signs of impaired circulation, such as numbness or tingling. If circulation is compromised, it requires immediate attention.
• Skin Condition: Examine the skin for any open wounds, cuts, or skin conditions that may affect the application of the cast or splint.
• Allergies: Ensure the patient has no known allergies to materials used in casts and splints, such as fiberglass or plaster.

Application of Casts and Splints

Once the assessment is complete, the healthcare provider will proceed with the application of the cast or splint. This process requires precision to provide proper support and immobilization. Some important considerations during application include:

• Pain Management: Administer pain relief if necessary, either before or during the application, to ensure the patient’s comfort.
• Proper Positioning: The injured limb should be positioned in the anatomically correct alignment to facilitate healing.
• Padding: Apply padding materials, such as cotton or felt, to prevent skin irritation and pressure sores under the cast or splint.
• Immobilization: Ensure that the cast or splint immobilizes the injured area adequately, preventing any movement that could hinder healing.
• Drying Time: Allow sufficient time for the cast or splint to dry and harden before the patient is discharged.

Educating the Patient

Patient education is a crucial aspect of caring for those with casts and splints. Patients need to understand how to maintain and monitor their condition to prevent complications and support the healing process. Key points to cover include:

• Weight-Bearing Restrictions: Explain any weight-bearing restrictions and provide assistive devices, like crutches or walkers, if necessary.
• Hygiene: Instruct patients on how to keep the cast or splint clean and dry to prevent skin issues and infections.
• Signs of Complications: Educate patients about the signs of complications, such as increased pain, swelling, or changes in skin color or temperature, which require immediate medical attention.
• Follow-Up Appointments: Stress the importance of attending scheduled follow-up appointments for cast or splint evaluation and potential adjustments.
• Mobility and Exercises: Encourage patients to perform prescribed exercises to prevent muscle atrophy and joint stiffness in the unaffected areas.

Daily Care and Maintenance

Caring for a plaster cast or splint doesn’t end after the initial application. Daily care and maintenance are essential to ensure the patient’s comfort and prevent complications:

• Skin Care: Inspect the skin around the cast or splint regularly for any signs of irritation, redness, or pressure sores. If moisture gets inside, use a hairdryer on a cool setting to help dry it.
• Itching: Patients may experience itching under the cast. Advise them not to insert objects inside the cast but instead gently tap or pat the outside to alleviate itching.
• Elevation: Encourage the patient to elevate the injured limb above heart level whenever possible to reduce swelling.
• Clothing and Covering: Suggest loose-fitting clothing that can easily be put on and taken off over the cast or splint. Some patients may also use cast covers to keep the area clean during activities like showering.
• Keep it Dry: Remind patients to keep the cast or splint dry at all costs, as moisture can weaken the materials and promote bacterial growth.

Dealing with Complications

Despite proper care, complications may still arise. It’s important for both patients and healthcare providers to be aware of potential issues and how to address them:

• Cast or Splint Damage: In the event of damage or cracking, patients should seek immediate medical attention. Do not attempt to fix it yourself.
• Cast Syndrome: This rare condition occurs when pressure from a tight cast compresses blood vessels, leading to abdominal pain and other symptoms. Patients should report any unusual symptoms promptly.
• Infection: If signs of infection, such as increased pain, redness, or discharge, develop, the patient should contact their healthcare provider immediately.
• Allergic Reactions: In case of severe skin irritation or rash, patients should consult their healthcare provider to rule out an allergic reaction to the cast materials.
• Cast Removal: Only a qualified healthcare professional should remove a cast or splint. Attempting to remove it at home can lead to injury.

Caring for patients with plaster casts and splints is a multifaceted process that requires attention to detail and continuous support. Proper assessment, application, patient education, daily care, and addressing complications are all essential components of successful treatment. By following these guidelines, healthcare providers and patients can work together to ensure a smoother and more effective recovery process, ultimately leading to a return to full mobility and functionality.