For the last anniversary in 2014, we had already thought about the future of the plaster cast. We focused on fiberglass bandages and orthoses as alternatives to plaster bandages. We have shown the pros and cons of the products and have seen that plaster has strong competition, but its use is favourable for certain applications. This trend, which we described 5 years ago, continues. Fewer and fewer people have arms or legs in casts. More orthoses are visible, but not in large numbers.
More operative treatments
The reason is that many fractures no longer be conservatively treated with an immobilizing bandage over a longer time, but treated surgically. The bones are restored during surgery by screws, nails or plates in the original shape. For example, in Germany about two-thirds of the wrist fractures are treated surgically. The dreaded risk of infection in an OR is now less than one percent. Often, no second procedure is necessary because the implants can remain in the body. After surgery, at most an orthoses is needed for short-term support.
The main goal is to restore mobility as quickly as possible after surgical or conservative stabilization of the fracture. So the adjacent joints should be able to be moved quickly and a partial load should be possible. As a result, the self-healing powers of the bone are stimulated more strongly. Plaster and fiberglass bandages that ensure complete immobilization have disadvantages compared to orthoses. Because with orthoses you can regulate the degree of mobility, they can also be removed for a certain amount of time. So with them a desired dynamic immobilization is possible. The complication of a thrombosis is reduced, a long physiotherapy after complete immobilization is avoided, and the body part regains full functionality faster.
The period in which the fracture must be stabilized remains as a niche for the completely immobilizing bandages plaster and fibreglass, as primary cast. This period is during operative treatment before and shortly after surgery, during conservative treatment shortly after the alignment of the bones. Thereafter, orthoses are the means of choice. For this period of time, plaster has an advantage over fiberglass because of its good price-performance ratio. It has proven itself as a circular bandage cut open for possible swelling, or as a padded plaster splint wrapped with an elastic bandage. Orthoses are mainly used as prefabricated products. The production of a customized orthosis with a 3D printer still takes a very long time, is very expensive and has little comfort for the patient.
Indications for a complete immobilization
For complicated fractures and even those in which an OP could not achieve optimal stabilization, a complete immobilization by plaster or fiberglass bandages may be required also for a longer period of time. In children, where you have to fear wrong movements, too early loading of the breakage or an unauthorized decrease of the orthosis, plaster or fibreglass bandages are preferable.
Plaster casts and plaster splints will not die out in the future. They have preferred uses, especially as primary cast, and are more likely to be used for shorter periods of time.