What is a cast?

A cast holds a broken bone in place as it heals. Casts also help to prevent or decrease
muscle contractions, and are effective at providing immobilization, especially after
surgery.

Casts immobilize the joint above and the joint below the area that is to be kept straight
and without motion. For example, a child with a forearm fracture will have a long arm
cast to immobilize the wrist and elbow joints.
What are casts made of?
The outside, or hard part of the cast, is made from two different kinds of casting
materials.

• plaster - white in color.

• fiberglass - comes in a variety of colors, patterns, and designs.

Cotton and other synthetic materials are used to line the inside of the cast to make it soft
and to provide padding around bony areas, such as the wrist or elbow.

Special waterproof cast liners may be used under a fiberglass cast, allowing the child to
get the cast wet. Consult your child's physician for special cast care instructions for this
type of cast.
What are the different types of casts?
Below is a description of the various types of casts, the location of the body they are
applied, and their general function.

Type of Location Uses

Cast
Short arm Applied below the Forearm or wrist fractures. Also used to hold the
cast: elbow to the hand. forearm or wrist muscles and tendons in place after
surgery.
Long arm Applied from the Upper arm, elbow, or forearm fractures. Also used
cast: upper arm to the to hold the arm or elbow muscles and tendons in
hand. place after surgery.
Arm Applied from the To hold the elbow muscles and tendons in place
cylinder upper arm to the after a dislocation or surgery.
cast: wrist.
Illustrations of arm casts, 3 types

Click Image to Enlarge

Type of Location Uses
Cast
Shoulder Applied around the Shoulder dislocations or after surgery on the
spica cast: trunk of the body to the shoulder area.
shoulder, arm, and
hand.
Minerva Applied around the After surgery on the neck or upper back area.
cast: neck and trunk of the
body.
Short leg Applied to the area Lower leg fractures, severe ankle sprains/strains,
cast: below the knee to the or fractures. Also used to hold the leg or foot
foot. muscles and tendons in place after surgery to
allow healing.
Leg Applied from the upper Knee, or lower leg fractures, knee dislocations, or
cylinder thigh to the ankle. after surgery on the leg or knee area.
cast:
Illustrations of leg casts, 3 types

Click Image to Enlarge

Type of Cast Location Uses

Unilateral hip Applied from the chest to the foot on Thigh fractures. Also used to
spica cast: one leg. hold the hip or thigh muscles
and tendons in place after
surgery to allow healing.
One and one- Applied from the chest to the foot on Thigh fracture. Also used to
half hip spica one leg to the knee of the other leg. A hold the hip or thigh muscles
cast: bar is placed between both legs to keep and tendons in place after
the hips and legs immobilized. surgery to allow healing.
Bilateral long Applied from the chest to the feet. A Pelvis, hip, or thigh fractures.
leg hip spica bar is placed between both legs to keep Also used to hold the hip or
cast: the hips and legs immobilized. thigh muscles and tendons in
place after surgery to allow
healing.
Illustrations of hip spica casts, 3 types

Click Image to Enlarge

Type of Cast Location Uses

Short leg hip Applied from the chest to To hold the hip muscles and tendons in
spica cast: the thighs or knees. place after surgery to allow healing.
Illustration of child wearing a short leg hip spica cast

Click Image to Enlarge

Type of Cast Location Uses

Abduction boot cast: Applied from the upper To hold the hip muscles
thighs to the feet. A bar and tendons in place after
is placed between both surgery to allow healing.
legs to keep the hips and
 legs immobilized.
Illustration of child wearing abduction boots

Click Image to Enlarge

How can my child move around while in a cast?

Assistive devices for children with casts include:

• crutches
• walkers
• wagons
• wheelchairs
• reclining wheelchairs

Cast care instructions:

Cast care

Keep your plaster cast dry at all times, or it will "melt." If it gets wet, it may soften or
crack and lose its proper position. (If you have a fiberglass cast, keep it as clean and dry
as possible.)

• If your cast gets dirty, you can clean it with a damp (not wet) cloth. Then, keep
the area uncovered until it's completely dry. To help dry the cast, you may use a
hand-held dryer on a cool setting (never use the hot settings because it might
burn you).
• If your cast starts to smell bad, rub a little bit of dry baking soda into the soiled
areas.
• Check daily to be sure the cast is not too tight or too loose. If you feel tightness,
pain, tingling, numbness, or you can't move your toes/fingers, or if there is
swelling, elevate your leg/arm on a pillow for one hour. If you don't feel better,
call your doctor. A cast that is too tight could cut off the blood supply or damage
nerves.
• The fingers/toes on the arm/leg with the cast should stay pink and feel warm, like
on the fingers or toes on the other side. Call your doctor if your fingers/toes
become swollen, cold, pale, or blue, or if you can't move them.
• Never put anything into the cast or play with small objects like coins and toys that
could fall down into the cast. Objects like coat hangers and pencils can break the
skin and cause infection. If this happens and you can't remove the item with your
fingers, call your doctor immediately.
 • Never stuff cotton or toilet tissue under the edges of the cast — it may decrease
blood circulation.
• Never trim or cut the length of the cast.
• Follow your doctor's instructions about physical activity carefully. Don't let your
child play in dirt or sand.

Older children with body casts may need to use a bedpan or urinal in order to go to the
bathroom. Tips to keep body casts clean and dry and prevent skin irritation around the
genital area include the following:

• Use a diaper or sanitary napkin around the genital area to prevent leakage or
splashing of urine.

• Place toilet paper inside the bedpan to prevent urine from splashing onto the cast
or bed.

• Keep the genital area as clean and dry as possible to prevent skin irritation.

In orthopedic medicine, traction refers to the set of mechanisms for

straightening broken bones or relieving pressure on the spine and skeletal
system. There are two types of traction: skin traction and skeletal traction.

It is largely replaced now by more modern techniques, but certain approaches

are still used today:

 Bryant's traction
 Buck's traction - hip fractures
 Dunlop's traction - humeral fractures in children
 Russell's traction
 Milwaukee brace

Skeletal traction

Although the use of traction has decreased over the years, an increasing number
of orthopaedic practitioners are using traction in conjunction with bracing
(see Milwaukee brace). The section below provides some details on traction and
its use.
Bryant's Traction

Bryant's traction is mainly used in young children who have fractures of

the femur or congenital abnormalities of the hip.[1] Both the patient's limbs are
suspended in the air vertically at a ninety degree angle from the hips and knees
slightly flexed. Over a period of days, the hips are gradually moved outward from
the body using a pulley system. The patient's body provides the countertraction.
Purpose

The purpose of traction is to:

 To regain normal length and alignment of involved bone.

 To reduce and immobilize a fractured bone.
 To lessen or eliminate muscle spasms.
 To relieve pressure on nerves, especially spinal.
 To prevent or reduce skeletal deformities or muscle contractures.

In most cases traction is only one part of the treatment plan of a patient needing
such therapy. The physician’s order will contain:

 Type of traction
 Amount of weight to be applied
 Frequency of neurovascular checks if more frequent than every four (4)
hours.
 Site care of inserted pins, wires, or tongs
 The site and care of straps, harnesses and halters
 The inclusion of any other physical restraints / straps or appliances (eg.
mouth guard)
 the discontinuation of traction

Responsibility of initial application

The physician is typically responsible for initial application of traction and weights
while the adjustment or removal (to perform ablution functions / physiotherapy) of
skeletal traction weights will be based on the doctors charted plan.
In most cases cervical traction may be adjusted or temporarily removed, per
physician order, by an orthopedic nurse who has documented competency to do
so.

The alignment and moving of the patient will only be changed on physician's
directive and the affected extremity will need to be maintained in proper
alignment at all times with the ropes and traction straps - making sure the
mentioned is unobstructed and weights hanging freely.

If it is necessary to move the patient while skeletal traction is in place, the patient
should be moved in the bed with weights hanging freely.

In most cases traction will be applied for a number of weeks to months and
Neurovascular checks will need to be performed by a nurse as ordered by the
physician or as dictated per traction unit policy.

Traction is an appropriate treatment for a number of medical problems including

spinal deformities such as scoliosis.