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Complications of a Cast or Splint

Instructor: Courtney Dohse
In this lesson, you will learn about the possible complications that may occur as a result of casting or splinting and how to quickly and easily recognize them upon assessment.

Alex is a three year old boy who sustained a compound fracture to his right wrist after falling off the playground at daycare. A cast is applied by his pediatrician and the boy is discharged home. Within the next few days, his mother notices increased sensitivity at the site of the fracture, despite it being casted. She also notices that Alex is not moving his fingers on the affected limb. She contacts his pediatrician who requests that Alex be seen in the office immediately.

Splints vs. Casts

It is important to understand the difference between casting and splinting when identifying a proper plan of care for the patient. Splints tend to be more forgiving, meaning that they are a little more flexible and able to accommodate swelling and movement. They usually do not wrap completely around the affected limb, but are still beneficial in immobilizing certain joints. Casts, on the other hand, are usually made of a hard plaster that wraps completely around the affected extremity. Casts are not flexible and do not allow for expansion if the patient experiences swelling.

Possible Complications of Splints and Casts

Joint Stiffness

When using splints or casts for a prolonged period of time, patients become at risk for increased muscle and joint stiffness. This can be short-term and easily resolved with stretching and exercises, but if immobilization occurs over too long of a period, this may become a long-term and chronic issue. It is important to limit the use of casts and splints to short term and to be sure to perform range of motion exercises once they are removed. In more serious injuries, the patient may benefit from physical therapy after the removal of the immobilization device.

Muscle Atrophy

If you have ever seen someone who has gotten a cast removed, it is usually quite noticeable that the extremity that was casted is significantly smaller in size than the unaffected limb. This is due to muscle atrophy, which is basically a wasting away of the muscle. When a muscle is 'out of commission' for a long period of time, it loses muscle mass, becoming very weak. There are different degrees of muscle atrophy, and some atrophy is to be expected due to disuse, but this can usually be corrected with physical therapy.

Infection

Our little patient, Alex, is especially at risk for infection, more so than an adult patient might be. First, he sustained his injury from falling off a playground. It is likely that he already has an open wound somewhere on his right forearm, which is the arm he fell on. This wound could potentially be a site for an infection to begin. Once casted, the area becomes dark and moist---the perfect breeding ground for bacteria. Additionally, being a child, he does not have the understanding for hygiene that adults may have. Many children who experience an 'itch' or tingling inside the cast will stick something inside the cast, such as a pencil, to be able to reach the itch. This often opens up the skin and creates the perfect site for bacteria to breed. As a healthcare provider, it is extremely important to educate the patient on the proper care of the cast such as keeping it clean, dry, and not attempting to put anything inside of it.

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