Parent's Info

Cast Care and information

An orthopaedic cast is a hard plaster or fiberglass shell with an inner padded surface that surrounds an injured extremity thereby preventing movement and providing protection.

By preventing movement, the cast immobilizes the underlying broken bone or torn ligament in the proper position allowing proper healing to occur

The duration the cast is used depends on the type of injury

Elevation of the affected limb for the first 3 days significantly reduces the natural swelling that occurs after an injury. Swelling is normal in the initial phase of the injury, usually lasting one to three days. The limb should be placed above the level of the patient’s heart by using either pillows or supporting the limb. Moving the fingers or toes of the affected limb may also assist in reducing swelling. A sling is not sufficient elevation of the upper limb.​

Pain relief in the form of Paracetomol, Ibuprofen or medication prescribed by your physician should be continued for at least the first 48 hours after injury. Medication should be taken as directed on the medication bottle. Ensure Ibuprofen or other anti-inflammatories are taken only after food.​

The skin should be checked for redness, swelling, bleeding, sores, or color changes around all the cast edges every day. The opposite limb may be used as a reference to determine worsening swelling or color changes.​

In addition, pain should be improving overall day by day. Pain which is worsening or not responding to medication is a concern.

Bathing the affected extremity with a cast should be avoided in most circumstances. Unless the patient has specifically been told they have a waterproof cast, the cast should not get wet. Wet plaster can become soft and crumble. Wet padding under a fiberglass cast can cause skin irritation, rash formation, and underlying damage.

A sponge bath is most desirable to avoid wetting the cast when the child needs bathing, but the cast should still be covered in several layers of towel or plastic bags to ensure it stays dry.

A variety of manufactured “shower/water safe” cast covers are available, but no single one is perfect. In the event a cast becomes wet, dry the cast with a hair dryer on the cool setting.

Placing objects within the cast must be avoided. At no time should the child place rulers, paper, pencils, pens, etc. into the cast. Furthermore, powders or lotions should not be placed in the cast. This does not mean the child or his/her friends cannot draw on the cast.

Itching under the cast can occur and may be bothersome, but under no circumstances should an object be placed under the cast. Scratching the underlying skin may cause injury and/or infection. Itching may be overcome by tapping on the cast or blowing cool air in to the cast with a hair dryer on cold setting. If itching becomes severe and/or persistent, please contact us.

Walking on a leg with a cast may damage the cast and underlying bone. Do not let your child walk on a cast.

Activities of daily living do not necessarily need to be restricted if your child has a cast. They may go to school and play. However, they must avoid activities that can lead to cast damage, reinjury, or wetting of the extremity. Examples of inappropriate activities include but are not limited to: bicycle riding, swimming, roughhousing, contact sports, skate boarding, etc.

Cast odor is normal and not an indication to change the cast. Odor is common because the affected limb cannot be bathed. Under no circumstances should powder or perfume be applied on or in the cast

A cast that is too tight may decrease circulation to the affected limb, damage underlying skin, and/or injure underlying nerves. The most common symptoms of a cast that is too tight are:

    • A feeling of numbness, tingling, or increased pain
    • The fingers or toes of the affected limb are a different color than the skin of the non-injured extremities (i.e. pale or blue)
    • New swelling of fingers or toes

Swelling is to be expected in the first 24‐72 hours after injury or surgery of the affected limb and may lead to the cast feeling tight. This is best treated with elevation of the affected extremity

A cast can become too loose, especially after the initial bout of swelling subsides. A child should not be able to remove the cast or significantly move the affected limb under the cast. Being able to place one or two fingers under a cast is appropriate

  • Your child feels numbness, tingling, or increased pain.
  • The affected fingers and/or toes turn an abnormal color such as white or blue
  • The fingers and/or toes become severely swollen.
  • Your child has trouble moving the fingers and/or toes of the affected limb
  • Pain under the cast becomes severe and not responding to medication
  • Any drainage comes through or out of the end of the cast.
  • A bad odor comes from underneath the cast.
  • You notice a stain or area of warmth on the cast.
  • Your child develops a fever.
  • The cast feels too loose or too tight.
  • The cast becomes soft or breaks.
  • The cast becomes significantly wet (non-waterproof cast)

If you have been informed your child has a waterproof/swimming cast. Most of the care of your cast follows the same guidelines as described above. In terms of getting the cast wet.

  • Getting the Cast Wet. The Delta-Dry padding is designed to allow you to get your cast wet should your doctor approve.
  • Drying the Cast. There are no special instructions in drying the cast. Water will drain out the lower end of the cast for several minutes after becoming wet. You may dry the exterior of the cast with a towel but do not attempt to dry the Delta-Dry padding within the cast. Do not cover the cast while it is drying as this will prevent the remaining water from evaporating from the cast.
  • Drying Time. Drying time will vary depending on the environment’s temperature, humidity and the size of the cast. The cast will usually drip dry for a few minutes and feel dry in about 90 minutes. Water can accumulate in the heel of a short leg cast or elbow of a long arm cast; make sure to let the foot or arm hang so that all water can drain from the cast.
  • Cleaning the Cast. Your cast should be rinsed thoroughly
    after swimming, getting the cast dirty or periods of excessive perspiration. You may use a mild soap solution when washing the cast but be sure to thoroughly rinse the cast with clean water.
  • Damaging the Cast Padding. Delta-Dry cast padding can become damaged. This may prevent it from working properly. The padding is most commonly damaged by placing foreign objects inside the cast.