NURS 17 MEDICAL AND SURGICAL NURSING

Application of Cast | 3rd Year | 2nd Semester - AY 2024-2025

• Plaster bandage consists of a cotton bandage that

has been combined with POP.
Outline:
I. Introduction • When water is added, the more soluble form of
II. Uses calcium sulfate returns to the relatively insoluble form,
III. Types and heat is produced.
IV. Classification Based on Pattern of Application • Hardens after it has been made wet.
V. Procedure • Still widely popular, it is cheap, non-irritant, and
VI. Cast Care
easy to apply.
VII. Complications
VIII. Removal
IX. Contraindications Application
Stage 1: Setting stage with a slight expansion in volume.
Stage 2: Hardening stage
INTRODUCTION
• A cast is a rigid external immobilizing device that is
Note: Movement of plaster while it is setting will cause gross
molded to the contours of the body.
weakening.
• A shell, frequently made from plaster or fiberglass,
encasing a limb (or large portions of the body) to
Setting Time Drying Time
stabilize and hold anatomical structures, most often Time taken to convert from Time taken for POP to
fractured bone/s in place until healing is confirmed. powder form to crystalline convert from crystalline form
• Various materials have been used since ancient times. form (3-10 minutes) to anhydrous form (36-72
USES OF CAST hours)
• To support fractured bones, controlling movement of REDUCED BY:
fragments and resting the damaged tissues. • High temperature Influenced by ambient
• Salt solution temperature and humidity.
• A plaster back slab can provide excellent pain relief.
• Borax solution
• To stabilize and rest joints in ligamentous injury. • Addition of resin Optimum strength is
• To support/immobilize joints and limbs post- • Reuse of dipping achieved when it is
operatively until healing had occurred. water completely dry.
• To correct deformities.
• External splint for blocking movements in cases of INCREASED BY:
• Low temperature
nerve, tendon, vessel injury after arthroplasty.
• Sugar solution
• To make negative mold of a part of body.
• Helps to prevent or decrease muscle contractions. Advantages Disadvantages
• A splint for undisplaced fractures. • Slower setting • Heavy
• External splint to aid with internal fixation of the • Can be used in an • Messy
fractures, osteotomies. acute setting • Significantly
IDEAL CHARACTERISTICS OF A CAST • Infinitely moldable weakened if cast is
• Suitable for direct application when wet wet
• Easy to mold • Does not cause • Partially radio-
allergic reactions in opaque
• Non-toxic for patient most people • Comes in only
• Unaffected by water • Easy to remove white color
• Transparent to X-rays • Cheap
• Quick setting • Durable
• Able to transmit air, water, odor, and pus
• Strong but light in weight FIBERGLASS CAST
• Non-flammable • Plaster cast made from fiberglass material.
• Non messy application and removal • Also called glass-reinforced plastic (GRP) or glass
• Long shelf life fiber reinforced plastic (GFRP), synthetic cast.
• Cheap • Fiber reinforced polymer made of plastic matrix
reinforced by fine fibers of glass.
Cast Materials:
• Fiberglass bandages are impregnated with
• Plaster of Paris (white in color) polyurethane.
• Fiberglass (variety of colors, patterns, and designs)
• Used mostly in those cases where the healing process
• Thermoplastics
has already began.
• Polyester/ Cotton Knit
TYPES
PLASTER OF PARIS Advantages Disadvantages
• Lighter • Costly
• Called calcined gypsum (roasted gypsum), ground
• Faster setting • Less pliable so
to a fine powder by milling.
• Three times more difficult to
stronger than POP mold (stiffer)
NURS 17 MEDICAL AND SURGICAL NURSING
Application of Cast | 3rd Year | 2nd Semester - AY 2024-2025

• Impervious to water • Higher risk of tendons in

• Radiolucent pressure and place after a
• Comes in different constriction of the dislocation or
color limb surgery
• Mot usually used in
acute conditions Shoulder Spica Applied around • After surgery
• More prone to give Cast the neck and trunk on the neck or
rise to allergic of the body upper back
reactions area.
(polyurethane may Minerva Cast Around the neck • After surgery
irritate skin) and trunk area of on the neck or
• Carcinogenic the body upper back
area.
CLASSIFICATION OF CASTS Short Leg cast Applied to the • Lower leg
area below the fractures.
BASED ON PATTERN OF APPLICATION knee to the foot • Severe ankle
Slab POP encloses partial sprains/strains,
circumference (e.g. short or fractions.
arm back slab) Leg Cylinder From upper thigh • Knee or lower
Cast POP encloses full Cast to the ankle leg fracture
circumference (ex: short
• Knee
leg full plaster)
dislocations
Spica Includes trunk and one or
• After surgery
more limbs (ex: hip spica)
on the leg or
Brace Splintage which can allow knee area
motion at adjacent joint
Unilateral Hip Applied from the • Femoral
Spica Cast chest to the foot fractures
Methods of Application of POP Cast on one leg • to hold the hip
Skin Tight Cast • Cast is directly applied over or thigh
the skin. muscles and
• Dangerous as it may cause tendons in
pressure sores. place after
• It is difficult to remove as the surgery to
hair may be incorporated allow healing.
into the cast and hence it is One and One- Applied from the • Femoral
not recommended. half Hip Spica chest to the foot fractures
Bologna Cast • Generous amount of cotton Cast on one leg to the • to hold the hip
padding is applied to the knee of the other or thigh
limb before putting the cast. leg. A bar is muscles and
• This is the commonly placed between tendons in
employed method. both legs to keep place after
Three Tier Cast • Stockinette is used first, the hips and legs surgery to
over which cotton padding immobilized. allow healing.
is done before applying the Bilateral Long Applied form the • Pelvis, hip, or
POP cast. Leg Hip Spica chest to the feet. A femora
• It is an ideal method, but is Cast bar is placed fractures.
expensive. between booth • Hold the hip or
legs to keep the thigh muscles,
hips and legs tendons in
Type of Cast Location Uses
immobilized. place after
Short Arm Cast Applied below the • Forearm or
elbow to the hand surgery to
wrist fractions.
allow healing.
• Hold the
forearm or wrist
Short Leg Hip Applied from • Hold hip
Spica Cast chest to the thighs muscles and
muscles and
or knees tendons in
tendons in
place after place after
surgery. surgery to
allow healing.
Long Arm Cast Applied from the • Elbow or
upper arm to the forearm
Abduction Boot Applied from the • Hold hip
hand Cast upper thighs to the muscles and
fractures.
feet. A bar is tendons in
• Hold arm or
placed between place after
elbow muscles
both legs to keep surgery to
and tendons in
the hips and legs allow healing.
place after
immobilized.
surgery.
Arm Cylinder Applied from • Hold elbow
Cast upper arm to the muscles and
wrist
NURS 17 MEDICAL AND SURGICAL NURSING
Application of Cast | 3rd Year | 2nd Semester - AY 2024-2025

• Put POP inside a bowl of water and allow air bubbles

to escape.
• Roll padding distal to proximal
• 50% overlap
• 2 layers minimum
• Extra padding at bony prominence (malleoli, patella,
and olecranon)
• Position the limb

PROCEDURE
BEFORE THE PROCEDURE
• Make sure to identify the patient.
• Examine the limb and fracture site
• Check for any skin lesions
• Assess neurovascular status
• Radiographs should also be reviewed thoroughly to • Padding/stockinette should not be too tight
determine fracture pattern • Wrinkling over flexion points and bony prominences
• Examination of the displacement and assessment of should be minimized by smoothing or trimming.
the forced required to reduce and hold reduction • Bring out POP, squeeze out water, apply, and mold.
• Determine the type of cast that is needed • Avoid molding with anything but the heels of the palm
• Explain the procedure the patient and expected in order to avoid pressure points.
outcome • Excess stockinette is folded back over the edges of
• Obtain informed consent the splint to form a smooth, padded edge.
• Assemble what you need for the procedure
➢ POP bandage
➢ Crepe bandage or Rolled gauze (for slabs)
➢ Casting gloves
➢ Basin of water
➢ Bandage scissors
➢ Padding (soffban or simple cotton)
➢ Sheets
➢ Tape
• Casting materials (available in various widths)
➢ 6 inches for thighs
➢ 3-4 inches for lower leg
➢ 3-4 inches for upper arm
➢ 2-4 inches for forearm

RULES OF APPLICATION OF POP CASTS

• Choose the correct size
• Usually the joint above and a joint below should be
ideally included.
THE PROCEDURE ➢ This is done to eliminate movements of the
• Having reduced the fracture joints on the either side of the fractures.
• Place joint in position of function
• It should be molded with the palm and not with the
• The padding (or Stockinette) is measured and applied fingers for the fear of indentation.
to cover the area and extend about 6cm beyond each
end of the intended cast site.
• The joints should be moved in functional position.
NURS 17 MEDICAL AND SURGICAL NURSING
Application of Cast | 3rd Year | 2nd Semester - AY 2024-2025

• The plaster should be snugly fit and should not be COMPLICATIOSN OF PLASTER
too tight or too loose. REASONS
• Uniform thickness of the plaster is preferred.
Improper Application • Joint stiffness and
malposition of limb
IMMEDIATE POST APPLICATION PRECAUTION
• Plaster blisters and sores
• Inform patient about thermal changes after • Pressure sores
application of plaster. Plaster allergy • Allergic contact dermatitis
• Observe for changes in skin color which can indicate • Skin symptoms of irritation
impairment of circulation. are usually all mild and
• Whenever possible, the injured limb should be temporary
elevated ➢ Quaternary
ammonium
➢ In case of arm and forearm, a sling may be
compound
used. BENZALKONIUM
➢ In case of lower limb, the leg may be elevated CHLORIDE is the
on pillows and the end of the bed raised. allergen
• X-ray should be done after application of each cast to responsible for
confirm the acceptability of reduction. POP-induced
allergic contact
• Purulent dermatitis
ASSISTIVE DEVICES FOR PATIENTS WITH CASTS:
Tight Cast • Edema distal to the plaster
• Crutches • Compartment syndrome
• Walkers (children) • Nerve palsy
• Wheelchairs • Circulatory complications
• Reclining wheelchairs • Gangrene complicating
CAST CARE fractures
• Patient or parent/guardian should be given written • Deep vein thrombosis
instructions on how to manage the fracture/cast. • Hypostatic pneumonia
• Disuse osteoporosis and
• Keep the cast clean and dry. renal calculus formation
• Check for cracks or breaks in the cast.
• Do not scratch the skin under the cast by inserting
DISEASES
objects inside the cast.
Plaster Disease • When a limb is put into
• Do not put powders or lotion inside the cast. plaster and the joints
• Cover the cast while eating to prevent food spills and immobilized for a long
crumbs from entering the cast. period.
• Prevent small toys or object from being put inside ➢ Joint stiffness
the cast. ➢ Muscle wasting
➢ Osteoporosis
• Encourage to move fingers or toes to promote
• This syndrome can be
circulation. reduced to a minimum by
• Do not use the abduction bar on the cast to lift or carry the early use of:
the child. ➢ Functional
• Use a diaper or sanitary napkin around the genital braces
area to prevent leakage or splashing or urine. ➢ Isometric
exercise
• Place toilet paper inside the bedpan to prevent urine ➢ Early weight
from splashing onto the cast or bed. bearing
• In case of itching, apply ice packs or place hair dryer • These in turn promote a
tool (cool air) against one of the ends to draw air in rapid retrieval of function.
through it. Fracture Disease • Prolonged immobilization
can lead to:
When to come back to the hospital? ➢ Vicious cycle of
pain
✓ Cast is too tight
➢ Welling
✓ Develops fever ➢ Unresolved
✓ Increased pain edema
✓ Increased swelling above or below the cast • Edema fluids congeal and
✓ Complaints of numbness or tingling gets converted to a
✓ Drainage or foul odor from the cast gelatinous material and
✓ Cool or cold fingers or toes deposited around joints
and tendons causing:
✓ Can’t move fingers or toes
➢ Joint stiffness
➢ Contracture
➢ Tendon
adhesion
NURS 17 MEDICAL AND SURGICAL NURSING
Application of Cast | 3rd Year | 2nd Semester - AY 2024-2025

• Muscle atrophy, brawny • It is important to form a therapeutic alliance with

skin/induration, and patient/caregiver and help them understand their role
osteoporosis follow. in care of cast and overall outcome of the treatment
• Reflex sympathetic plan.
dystrophy may sometimes
occur and further
complicate the picture.

REMOVAL
Duration to keep plaster or cast in place is dependent upon:
• Fracture site
• Type
• Soft tissue condition
• Functional condition of the limb
TIME DURATION
Children Upper limb: 3 weeks
Lower limb: 6 weeks
Adult Upper limb: 6 weeks
Lower limb: 12 weeks

INSTRUMENT USED
Shears • Heel of the shears must lie
between plaster and skin
• Avoiding bony
prominences
• Route of the shears
should lie over
compressible soft tissue
• Lower handle should be
parallel to the plaster
Electric Saw • Do not use unless there’s
wool padding
• Do not use over bony
prominences
• Cutting movement should
be up and down not lateral
• Do not use blade if bent,
broken, or blunt.

CONTRAINDICATIONS
• Open fractures
• Impending compartment syndrome
• Neurovascular compromise
• Developing or active reflex sympathetic dystrophy
• Skin infection or ulcers
• Swelling of the limb
• Allergy to cast materials
• Comminuted fractures

CONCLUSION
• Cast application is given for treatment of fractures and
other orthopedic ailments
• Though a very safe mode of treatment, complications
may occur.
• For the successful treatment of patients, it is important
to appreciate:
➢ How cast works
➢ How it should be used
➢ What can go wrong
• We should remember that ambulation with casts is
important and patient may require assistive devices.