Cast/Splint Care

WHAT MATERIALS ARE USED IN A CAST/SPLINT?
Fiberglass or plaster materials form the hard supportive layer in cast/splints. Fiberglass is lighter in weight, longer wearing, and “breathes” better than plaster. Plaster is less expensive than fiberglass and shapes better than fiberglass for some uses. Both materials come in strips or rolls, which are dipped in water and applied over a layer of cotton or synthetic padding covering the injured area. X-rays to check the healing process of an arm or leg within a cast/splint penetrate or “see through” fiberglass better than plaster.

HOW IS A CAST/SPLINT APPLIED?
Both fiberglass and plaster cast/splints use padding, usually cotton, as a protective layer next to the skin. The cast/splint must fit the shape of the injured arm or leg correctly to provide the best possible support. While the cast/splint is drying (it will only take about 15 minutes), you must hold your arm or leg in the position it was in when the cast/splint was applied. Generally, the cast/splint also covers the joint above and below the fractured bone. Frequently, a splint is applied to a fresh injury first and, as swelling subsides, a full cast may be used to replace the splint. Sometimes, it may be necessary to replace a cast as swelling decreases and the cast “gets too big.” Often as a fracture heals, a cast may be replaced with a removable splint or boot to allow easy removal for therapy.

Swelling due to your injury may cause pressure in your cast/splint for the first 48 to 72 hours. This may cause your injured arm or leg to feel snug or tight in the cast/splint.

TO REDUCE SWELLING

• Elevate your injured arm or leg above your heart by propping it up on pillows or some other support. You will have to recline if the cast/splint is on your leg. Elevation allows clear fluid and blood to drain downhill to your heart.
• Move your uninjured, but swollen fingers gently and often.
• Apply ice to the cast/splint. Place the ice in a dry plastic or ice pack and loosely wrap it around the splint or cast at the level of the injury. Ice that is packed in a rigid container and touches the cast/splint at only one point will not be effective.

THE FIRST FEW DAYS
To help you get used to your new cast/splint, take time to adjust your balance to the extra weight by moving carefully and deliberately until you are comfortable with it.

BE PATIENT WITH YOURSELF!
Getting to and from class will be harder and it will take a little longer to do things, so give yourself extra time to get dressed in the morning and to get to class. Don’t push. Contact the Emergency Dean’s Office at 333-0050 and/or DRES at 333-1970 if your cast/splint makes it difficult to get to class etc.

GENERAL PRECAUTIONS
The following precautions should help you to get back to normal as quickly as possible:

1. Follow your physician’s instructions.
2. Move your uninjured, but swollen fingers and toes gently and frequently to prevent joint stiffness.
3. Elevate your injured limb above your heart whenever possible for the first 24-72 hours to help reduce pain and swelling.
4. Avoid bumping or knocking your cast/splint against hard surfaces.
5. If you have a leg cast/splint, it may take your shoulders and arms a few days to get used to using crutches. Try to avoid overdoing it at first.
6. If you have an arm cast/splint, you may be given a sling for the first few days.
7. To avoid getting your cast/splint wet when taking a shower, cover it with a plastic bag and secure the bag to your skin with waterproof tape, making sure that it does not allow water to leak in. You may purchase waterproof shields for your cast/splint. If possible, use a hand-held showerhead and try to direct the water away from it. If you do get your cast/splint wet, contact your physician.

WARNING SIGNS FOLLOWING CAST/SPLINT APPLICATION

If you experience any of the following warning signs, contact your doctor’s office immediately for advice.

• Persistent pain
• Your cast/splint feels too tight
• Your cast/splint becomes loose, broken, or cracked
• You have painful rubbing under your cast/splint
• You experience coldness or notice a whitish or bluish discoloration of your fingers or toes
• You have pain, numbness or a tingling in your fingers or toes
• You notice any drainage or unusual odor from you cast/splint

TAKING CARE OF YOUR CAST/SPLINT

• After you have adjusted to your cast/splint for a few days, it is important to keep it in good condition. This will help your recovery.
• Keep your cast/splint dry. Moisture weakens plaster and damp padding next to the skin can cause irritation. Use two layers of plastic or purchase waterproof shields to keep your cast/splint dry while you shower/bathe. Call your physician if your cast becomes wet. If you are unable to contact your physician, phone Dial-A-Nurse at 333-2700.
• Do not walk on a “walking cast” until it is completely dry and hard. It takes about one hour for fiberglass, and 2-3 days for plaster to become hard enough to walk on.
• Keep dirt, sand, and powder away from the inside of your cast/splint.
• Do not pull out the padding from your cast/splint.
• Do not stick objects such as coat hangers inside the cast/splint to scratch itchy skin.
• Do not apply powders or deodorants to itchy skin. If itching persists, contact your physician.
• Do not break off rough edges of, or trim, the cast/splint before asking your physician.
• Inspect the skin around the cast/splint. If your skin becomes red or raw around the cast/splint, contact your physician.
• Inspect the cast/splint regularly. If it becomes cracked or develops soft spots, contact your physician.

CAST REMOVAL
The equipment used to remove your cast/splint is fitted with a special blade that vibrates, but does not rotate, and will not cut your skin. When the cast/splint is being removed, you may feel a little warmth or tingling, but that's all.

RETURNING TO NORMAL
Ask your physician what activity level you may resume and follow the guidelines as given. If any rehabilitation is needed, your physician will refer you.

References
“Nursing Process Overview: The Patient with a Cast.” Lippincott Manual of Nursing Practice, 5th Edition 1991 - pp. 181-184.
Textbook of Medical - Surgical Nursing. 6th Edition, 1998. Chapter 56 - pp. 1546-1550.

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