Plasters And Splints in Fractures

Introduction:

An injury like a fall on the ground, road traffic accident, physical violence, etc., can lead to fractures. And in fracture treatment, stabilization and immobilization of the fractured site is the chief factor responsible for successful healing. Casts and splints help protect the broken bone and injured soft tissues and immobilize them. After fracture, doctors manipulate the fracture to align the broken bone and stabilize it by applying a cast or splint. The cast holds the bones in place and restricts their movement while they unite. It also helps reduce pain, swelling, and muscle spasm.

In some instances (extensive fracture) following surgery, splints and casts are applied to immobilize bones or joints.

What Are Splints and Casts?

Splints are nothing but "half-casts" and offer less stability than the casts. But splints are malleable, adjustable, and can be accommodated according to the type of injury or swelling. The doctor decides which type of support suits the situation. In most fracture cases with significant swelling, your doctor might initially suggest stabilizing the fractured region with a splint until the swelling subsides and then replacing it with a cast.

Casts are mechanical supports applied surrounding the fractured limb to stabilize, immobilize, and protect the region from further injury.

What Types of Splints and Casts Exist?

A cast is custom-made as it must fit according to the shape of the injured limb. Casts and splints can be made from 'plaster of Paris' or fiberglass.

Plaster of Paris or fiberglass can be molded according to individual needs to make custom-made splints. Nowadays, readymade splints of various sizes and shapes, attached with velcro straps, are available, which are comfortable and easier to use.

Recently, thermoplastic material has been introduced, which has the advantage of being lightweight with excellent esthetics. This material is being used for making casts and splints.

Plaster of Paris: Plaster bandage is the traditional material used to make casts and splints. Plaster can be molded better than fiberglass and is cheaper. The disadvantage is that it is heavy and weaker than fiberglass.

Fiberglass: This is also known as synthetic casts. Fiberglass is light in weight, strong enough to hold the weight of the patient, and easy to apply.

How Are Casts and Splints Applied?

Initially, soon after an injury, splints are applied. As the swelling subsides, a full cast can be applied if necessary. Before application of a cast or splint, the fractured area is covered with a protective layer of soft cotton padding and to cover the bony prominences.

Both splints and casts are available in strips or rolls, which are dipped in water and applied over the padded area. The splint or cast is adapted to fit the shape of the injured limb and also covers the joint above and below the broken bone to restrict any movement.

Be informed that you can experience heat as the plaster sets (due to setting reaction). Though it dries within 15 minutes, it might take at least two days to get completely set. And extreme care should be taken to not distort or break the cast during this period.

In some instances, after a swollen limb improves (swelling decreases), the cast may have to be reapplied. As the swelling comes down, the fracture may lose alignment in rare cases. It may be necessary to realign and reapply the cast in such conditions.

Sometimes, when the fracture is healing, the cast may be replaced with a splint to facilitate rehabilitative exercises

How Should One Take Care of the Splints and Casts?

1. Soon after wearing a cast initially (in the first 48 to 72 hours), you may experience tightness inside the cast or splinted area, which is caused due to injury. In the case of a splint, the doctor can help you by adjusting the splint for you.

2. And to decrease the swelling, you will be advised to keep the injured limb elevated and give some active movements to the toes or fingers, as advised by your treating doctor.

3. You should take care to keep the plaster off the water. Also, do not insert or keep any object inside the plaster. If there is a lower limb splint or cast, you are not advised to walk on them.

4. When you have a shower, protect the cast or splint with a plastic cover or waterproof plaster covers. If they get wet, they can get disintegrated or can develop cracks.

5. Do not exert pressure or apply weight over the cast.

6. Make sure dust or sand does not enter the gaps between your limb and cast.

7. Do not use a sharp object to scratch if you experience itching within the plastered region. If it causes any cuts within, there is a possibility of infection.

What Complications Could Casting Cause?

Extended periods of wearing a cast or tight casts can cause the following complications:

• Pressure Sores: Excessive pressure exerted by the cast on a specific site of the limb or improperly fitting casts can cause sores on the skin.

• Compartment Syndrome: Tight casts exert pressure on the limb, and pressure within the cast increases. This pressure damages the nerves, blood vessels, and muscles of the part of the limb covered with the cast. If not identified and treated immediately, the damage can become permanent.

How Do I Know if I Have a Too Tight Cast?

Sometimes swelling or improper cast application techniques can cause tight casts or splints. In such as case, immediately seek your doctor's help if you observe:

• Increasing pain.

• The tight feeling within the cast.

• Numbness and tingling sensation in the injured limb.

• Excessive and progressive swelling below the cast.

• Loss of movements of the toes and fingers of the fractured limb.

How Is Cast Removal Done?

Your doctors will advise you about this at the time of removal of the cast. Your cast will be cut and removed with the help of an oscillating saw or scissors. After the removal of the cast, the skin may be dry with layers of peeled-off dead skin. They can be removed with a good wash with soap and the application of moisturizers.

You may also feel the stiffness of the joints and some wasting of the muscles around the joints, which can be rectified with physiotherapy exercises after the removal of cast or splint.