General Fracture Management - Casting

Below knee cast
Above knee cast
Short and long arm casts
Complications of casts and splints

Goal is semi-rigid immobilisation with avoidance of pressure and skin complications. 

A few pointers on different casts

Below knee cast 

• Support metatarsal heads and ensure the freedom of the toes. 
• Ankle should be placed in neutral dorsiflexion (no equinus). 
• Pad the fibula head and the plantar aspect of the foot. 

Above knee cast 

• Apply below knee first. 
• Maintain knee flexion at 5 – 20 degrees. 
• Extra padding anterior to the patella. 
• Support the supracondylar femur for rotational stability. 

Short and long arm casts 

• MCP should always be free. 
• Do not go past the proximal palmar crease. 
• Thumb should be free to the base of the metacarpal, opposition to the fifth digit should be unobstructed. 

Complications of casts and splints 

• Pressure necrosis. 
• Compartment syndrome. 
• Thermal injury. 
• Cuts and burns during cast removal. 
• Thrombophlebitis and deep venous thrombosis. 
• Joint stiffness. 
• Loss of reduction.