Cast and Bandage: Types and Uses

Cast and Bandage

• A cast is an immobilizing device made from plaster or fiberglass (or water-activated polyurethane resin) bandages shaped to the body part, encasing it.
• Casts help promote healing, stabilize fractures, and support musculoskeletal conditions like sprains, strains, dislocations, and tendon injuries.
• Casts can be used after specific orthopedic surgeries or to correct deformities, like clubfoot.

Types of Cast Materials

• Plaster of Paris (POP): An older, traditional material. It becomes malleable when mixed with water, hardening as it dries. It's relatively inexpensive but heavier and less breathable than other options. Drying time is 24-72 hours.
• Fiberglass: Lighter and more durable than plaster. Consists of layers of fiberglass fabric impregnated with a water-resistant resin. It's available in various colors, resists water, and sets quickly (within 30 minutes).
• Polyester: Similar to fiberglass but made from polyester fabric instead. Offers good strength and durability, is lightweight, and water-resistant.

Types of Casts and Applications

• Upper Limb Casts:
  • Short arm cast: Extends from below the elbow to the proximal palmar crease.
  • Gauntlet cast: Extends from below the elbow to the proximal palmar crease and the thumb (thumb spica).
  • Long arm cast: Extends from the upper axillary fold to the proximal palmar crease. The elbow is typically immobilized at a right angle.
• Lower Limb Casts:
  • Short leg cast: Extends from below the knee to the base of the toes.
  • Long leg cast: Extends from the upper thigh to the base of the toes. The foot is at a neutral position.
• Body Casts: Encircles the trunk, stabilizing the spine. Various types, including Milwaukee, Boston, Chêneau, Lyon, TriaC, SpineCor, ScoliSMART, and Flexpine casts.
• Spica Casts: Incorporate the trunk and extremities; the hip spica casts are common examples (single, one-and-a-half, and double hip spica).
• Shoulder spica cast: A body jacket encompassing the trunk, shoulder, and elbow.

Complications of Casts

• Pressure Ulcers: Pressure from the cast on neurovascular and bony structures can cause necrosis, pressure sores, and nerve palsies.
• Compartment Syndrome: Increased pressure in a confined space, like a limb, compromises circulation and function. It's often signaled by pain, paresthesia, pallor, pulselessness, poikilothermia, and paralysis.
• Immobility: Results in complications like nausea, vomiting, abdominal distention, adynamic ileus, and potential intestinal obstruction. Also includes acute anxiety reaction symptoms, thrombophlebitis (and possible pulmonary embolism), respiratory atelectasis and pneumonia, urinary tract infection, renal and bladder calculi, anorexia, constipation, and psychological reactions.

Assisting With Casting-Plaster and Fiberglass

• Equipment: Appropriate padding (Webril), stockinette, plaster/fiberglass rolls, warm water bucket, tape, protective clothing, gloves, immobilizers, crutches.
• Action Steps: Wash hands, wear protective clothing/gloves, place plaster into water until bubbles stop, remove and squeeze, open fiberglass rolls, help the person applying the cast.

Nursing Interventions

• Assess neurovascular and skin integrity: Observe for circulation (color, temperature, capillary refill, movement, sensation). Check for pressure points, watch for swelling, redness, or open lesions.
• Carefully assess positioning and potential pressure sites.
• Monitor signs and symptoms of complications.
• Elevate extremities and reposition.
• Maintain cast cleanliness and dryness.
• Assess for symptoms suggestive of infection or complications.

Elastic Bandages

• An elastic bandage is a stretchable woven fabric used to wrap injured or swollen areas.
• It applies compression and support to reduce swelling, relieve pain, and prevent future injuries.
• It can also secure splints or dressings.
• The size and type vary with the body area.

Explore the different types of casts used in orthopedic care, including plaster, fiberglass, and polyester. Understand their properties, benefits, and applications in stabilizing fractures and musculoskeletal injuries. This quiz will enhance your knowledge about the healing processes facilitated by these immobilizing devices.