How to Care for a Family Member with a Cast

How to Care for a Family Member with a Cast

by Patty

What to look for and when to call the doctor or go to the emergency room

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Most families have at least one member that has had the unfortunate experience of breaking a bone. Children can fall out of trees, off playground equipment, or down a rocky hill. Adults can fall in a variety of ways such as falling off a ladder, slipping in a tub, or on the proverbial banana. Whatever the cause of the fall or the age of the person, there are certain basics that are important to know when a cast is applied.

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As with any broken bone a trip to the emergency room is a must. With a fresh injury, a plaster cast may be applied first, and then as the swelling subsides, a fiberglass cast may be applied later. A stockinette is first applied over the skin to provide protection, then padding is applied next to pad bony surfaces and to help prevent pressure areas and skin breakdown. Plaster casts are not waterproof and therefore should not be allowed to get wet under any circumstances. On occasion a broken bone may penetrate the skin or is not reducible (put back in place) by external manipulation and requires surgical intervention. If this is the case, post-surgical bleeding would be expected. This may require a window to be cut into the cast in order to provide a way to change the dressing over the wound. Fiberglass casts are waterproof and won't disintegrate when wet, but do not get any cast wet without your doctor’s permission. The casting material comes on a roll that is dipped in water. This causes a chemical reaction, which may cause a warm sensation on the skin. Avoid putting pressure on the cast until completely dry. The cast needs up to 48 hours for the drying process. When a cast is applied, do not leave the emergency room if you have any sharp or rough areas around the edges that are causing irritation.All of the edges should be thoroughly padded to prevent redness or infections.

Typically, there is swelling present when a bone is fractured. This blog does not address emergency care of a fractured bone. After cast application, it is very important to keep the limb, arm, or leg elevated to help reduce swelling and to prevent further swelling. Swelling may cause very serious complications and must be managed correctly. Keeping the extremity elevated above the level of the heart will facilitate a reduction in fluid buildup. It will not take long to find out that hanging a casted leg or arm down (dependent position), causes swelling and pain. A sling will provide needed support and elevation for the casted arm. Multiple pillows offer a way to keep the casted leg elevated.

Arm Cast Cover - Coveroops

There are" five P's" to observe with any cast application:

PAIN - It is expected that intense pain would be present with any fracture. Casting the area and therefore getting the bone ends in alignment can reduce discomfort as the bone has been stabilized, but pain can still be acute for a couple of days. The physician may prescribe pain medication for a short period of time. More complex fractures may cause extended pain depending on the need for surgical procedures.

PALLOR - Pallor is an absence of normal color. Fingers or toes may appear pale, lacking in color. This may be an indication of poor circulation to the area usually due to swelling.

PARESTHESIAS – This is a sensory loss such as numbness or a tingling sensation. Paresthesias can occur from compression of a nerve, from swelling, or from pressure. These symptoms should be taken seriously and a doctor should be called.

PARALYSIS – This is an inability to move the extremity. There may be nerve compression and this should not be ignored.

PULSELESSNESS - When feeling for the radial pulse (at the wrist) or the pedal pulse (on top of foot approximately 1 ½ inches above the toes), no pulse is felt. Look for a bluish/gray color to the nail beds. If you press on the nail bed and it does not blanch (lose color) and refill with a nice pink color, this would indicate lack of circulation or at least poor circulation. This needs immediate attention. Note that sometimes the pedal pulses are difficult to assess unless you are trained to palpate (feel) these. In this case, look at the nail beds for that nice pink color. If the nail beds are pink, blanching, and refilling well, the circulation is most likely fine.

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Use common sense when taking care of a casted limb. Never put something down into the cast to “scratch” itchy skin. One of my former patients used a long comb to scratch inside of their cast. The comb fell down into the cast and they were unable to get it out. They ignored the problem and did not tell anyone. When the cast came off, there was a large ulcerated sore in the shape of a comb where the comb had pressed on the skin for weeks. As you can see, it is very important never to put any object into a cast. If an object does inadvertently become lodged in a cast, seek medical attention.

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If your child complains of itching, try using a hair dryer set on COOL to blow air into the cast. A fiberglass cast will allow the air to circulate soothing the skin. 
If the skin remains wet or perspiration causes too much moisture, this may result mold growth or a possible infection. If having a problem with wetness, call the MD.

Keep all doctors’ appointments as your MD may notice something that you don't notice that needs attention.

Never walk on a leg cast before the doctor gives permission. If you have a leg cast, a special heel is applied to the plaster (walking cast) or a special cast boot will be provided. DO NOT WALK on the casted limb without specific permission from the doctor. If the bone is not healed adequately this could cause major complications. Crutches or a walker would be necessary when the physician orders NWB (non-weight bearing) or PWB (partial-weight bearing). Avoid full weight bearing until given permission.

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When it is time for the cast to come off, often people are afraid that they will get cut from the circular blade. It appears that the blade is whirring around in a circular motion, but in reality the blade does not turn in a circular motion, but vibrates at a very high speed side to side, thus making it very safe. Also don't forget that there is thick padding under the casting material. Once the cast is removed the extremity may look pale, thin, and have a dry or scaly appearance to the skin. This is normal as it has not been exposed to the sun, the muscles have not been used as normal, and there is an accumulation of dead skin cells that would normally have been washed off with bathing.

This information is not intended to replace your medical practitioners care. There are more in-depth complications that were not covered here. Always consult your physician with any concerns or questions you may have.