Medical casts are used especially for the treatment of fractures. The broken bones are fixed from outside by a cast. This is called a conservative treatment in contrast to a fixing of the bones inside by artificial parts during an operation.
Immobilising bandages are also used to relieve pain, for example after strains and bruises or after operations on limbs, as well in the case of inflammation and irritation of joints and tendons. As a result of bacterial infections, they can support the immune defence. Hard bandages are also used for ligament and tendon injuries, especially after surgical reconstruction.
Undisplaced fractures and those that are stable after alignment do not require surgery. Conservative treatment has fewer risks and requires fewer technical requirements. However, it takes longer to restore function after immobilisation. Physiotherapy is usually necessary for this.
Screws, plates and nails or wire, usually made of titanium or stainless steel, are inserted to fix the bone parts. They are removed from the body approximately one year after healing. The advantage of this method is the short period of immobilisation immediately after the operation. Because movement can be allowed soon afterwards, muscle loss is minimised.
However, surgical interventions harbour risks such as bleeding, nerve damage, infections caused by germs, wound healing disorders and excessive scarring. Surgery is necessary if a bone fragment has penetrated the skin (open fracture) and in the case of fractures that shift again after the fragments have been set.
Around five per cent of fractures heal badly or not at all. Surgery can then be performed, which is usually necessary several times. The fracture sites are roughened with files and pressed together with screws. Alternatively, high-energy waves can be focussed on the bone ends from the outside. This also ruptures the encapsulation at the fracture sites and stimulates bone growth. The success rate of shock wave therapy is over 70%.
A medical cast is used for healing. It must fit well and must not cause any additional discomfort. Therefore, a doctor should be consulted immediately if any of the alarm signs shown here with symbols occur. The cause may be increased internal pressure or thrombosis. In these cases, the bandage must be removed immediately. Side effects can also be a decrease in muscle mass or stiffening of the joints.
Progressive pain. Feeling that the cast is too tight.
Severe swelling of toes or fingers.
The colour of fingers or toes turns into blue or white.
Feeling of numbness, tingling, sudden immobility of toes or fingers.
Venous thromboses can occur in casts, i.e. vascular blockages caused by clotted blood clots. This is caused on the one hand by damage to the vessel wall and an increased tendency to blood clotting following an accident or operation. On the other hand, the lack of muscle activity slows down the return flow of blood to the heart.
Thrombosis is suspected if pain increases under the bandage or swelling of the toes or fingers does not subside. A rapid diagnosis is important as the clots can break free and travel to the lungs or heart, where they can cause a life-threatening embolism.
As a preventative measure, the immobilised extremity should be elevated as often as possible and toes or fingers should be moved. This facilitates the return flow of blood, reduces the risk of clot formation and prevents swelling. If you have existing vein problems, are overweight or are taking hormones for contraception, there is an additional risk of thrombosis. In this case, medication that reduces blood clotting should be taken during the immobilisation period.
Muscle mass is reduced by the organism if the muscles in the cast are immobile. This muscle atrophy can be counteracted if fingers or toes are moved more often and the muscles in the bandage are occasionally tensed. Overall, the immobilisation should only last as long as absolutely necessary.
Increased pressure within a cast causes severe, sometimes irreversible damage to tissue, nerves and muscles. Symptoms include an increase in pain, circulatory and sensory disorders (blue or white colouring of the skin, tingling) and ultimately loss of movement in the toes or fingers.
Swelling after an accident or operation can cause an increase in pressure in the bandage. In these cases, the cast should be cut open immediately after application and wrapped with an elastic bandage. Pressure and haemostasis can be avoided already during application by using good padding and not wrapping the bandage too tightly.
Prolonged immobilisation also poses the risk of joints becoming stiff. Their natural mobility is lost due to the adhesion of sliding structures. Therefore, only those joints that must be immobilised should be included in the cast and remain in it as briefly as possible. Rehabilitation to restore mobility, musculature and resilience should always follow immobilisation.
Handle the cast carefully so that it can protect the injury and support healing. A freshly applied plaster cast reaches its final strength after about two days. During this time, it should be treated extremely gently. Fibreglass casts are stable and resilient within an hour. Please inform your doctor if the cast is damaged or too loose.
Plaster casts must always be kept dry, otherwise they lose their stability. Fibreglass casts are insensitive to water, however, no moisture should penetrate inside, as a wet padding dries only with difficulty and can cause skin irritations.
By elevating the limb, pain can be reduced and swelling can be avoided. To support blood circulation, you should often move the joints outside of the cast, especially fingers or toes, and also tense the muscles in the bandage. However, you must not put pressure on leg casts earlier as told by the physician.
If the skin under the bandage itches, do not insert objects to scratch. You can injure the skin, parts (e.g., caps of pens) can get stuck in the bandage and cause problems. Also, do not apply powder or deodorants to itchy skin, this can intensify the irritation.
