Care of Casts and Splints
Splints and casts support and protect injured bones and soft tissue, reducing pain, swelling, and muscle spasm. In some cases, splints and casts are applied following an initial injury or surgery. Splints or "half-casts" are better suited to accommodate swelling from injuriesthan enclosed casts. Docotr Biehl will decide which type of support will be best for you. Casts are custom-made and applied by Doctor Biehl or his assistant. Casts are typically made of fiberglass but are ocassionaly made of plaster. Splints can also be custom-made, especially if an exact fit is necessary. Other times, a ready-made off-the-shelf splints will be used. They have Velcro straps, which make the splints easy to adjust, and to put on and take off.
Fiberglass typically forms the hard supportive layer in splints and casts. Fiberglass is lighter in weight, less messy, stronger, more durable, and "breathes" better than plaster. Both materials come in strips or rolls, which are dipped in water and applied over a layer of cotton or synthetic padding covering the injured area. X-rays are used to check the healing process of an arm or leg in a splint or cast. The x-ray can be shot right through the cast. Frequently, a splint is applied to a fresh injury first and, as swelling subsides, a full cast may be used to replace the splint. Sometimes, it may be necessary to replace a cast as swelling decreases and the cast "too loose".
If your treatment is to be successful, you must follow Doctor Biehl's instructions carefully. The following information provides general guidelines only. Swelling due to your injury may cause pressure in your splint or cast for the first 48 to 72 hours. This may cause your injured arm or leg to feel snug or tight in the splint or cast.
To reduce the swelling:
1) Elevate your injured arm or leg above your heart by propping it up on pillows or some other support. You will have to recline if the splint or cast is on your leg.The injured body part must be elevated higher than the level of your heart so that clear fluid and blood can drain "downhill" to your heart. This is most important for the first 24-72 hours after the injury.
2) wiggle your uninjured, but swollen fingers or toes gently and often to pump fluid out of the injured area.
3) Apply ice to the splint or cast by placing the ice in a dry plastic bag or ice pack and wrap it around the splint or cast at the level of the injury. DO NOT LET WATER FROM THE MELTING ICE SEEP INTO YOUR CAST!!!
If you experience any of the following warning signs, attempt to the decrease swelling by following the instructions above. If those measures fail, contact Doctor Biehl's office immediately for advice.
1) Increasing pain, which may be caused by swelling, and the feeling that the splint or cast is too tight.
2) Increasing numbness and tingling in your hand or foot, which may be caused by too much pressure on the nerves from a tight cast.
3) Burning and stinging, which may be caused by too much pressure on the skin.
Keep your splint or cast DRY. Moisture can weaken fiberglass and plaster. However, the main problem is the damp padding next to the skin which can cause irritation. Once the padding becomes wet, it is extremely difficult to dry. You can develop a severe "diaper rash" of the forearm. In addition, the wet cast padding can get out of position and bunch up under the cast causing pressure sores of the skin. Sometimes you can use a blow dryer with warm air (not hot air which can burn your skin) to get the cast to dry out. If the cast becomes wet, it usually needs to be replaced in 48 hours.
You should not swim with a cast on. You should not take a bath with a cast on. Bathing shold consist of sponge baths or shower. Use a thick plastic bag with rubber bands to cover your cast. Place a towel around the entrance of the cast under the bag to catch any slight leakage that may occurl. You may also purchase waterproof shields to keep your cast dry while you shower. Please ask Dr. Biehl's assistant.
Do not let dirt, sand, or powder get inside of your splint or cast.
Do not pull out the padding from your splint or cast.
Do not stick objects such as coat hangers inside the splint or cast to scratch itching skin.
If itching persists, try blowing warm air inside your cast or try over the counter Benadryl
Do not break off rough edges of the cast or trim the cast before asking your doctor.
Do not remove the cast yourself. You may cut your skin or prevent proper healing of your injury. Doctor Biehl will use a cast saw to remove your cast. The saw vibrates, but does not rotate. The blade of the saw touches the padding inside the hard shell of the cast. This will cause the padding to vibrate and tickle. Cast saws make a lot noise and may feel "hot" from friction. If the padding has been pulled out, the skin can start to burn. That is why you should not pull out your padding.
Inspect the cast regularly. If it becomes cracked or develops soft spots, contact Doctor Biehl's office.