Complications of Plaster Cast

A plaster cast is given for treatment of fractures and other orthopedic ailments. Though a very safe mode of treatment, complications of plaster may occur.

Main complications of plaster are stiff joints, muscle wasting and impaired circulation. Physiotherapy and good nursing can help reduce these complications and speed the final recovery.

Complications of plaster cast can be divided in systemic, which affects whole body or local which affects limb where plaster has been applied.

Local complications of plaster can be further classified as immediate and delayed.

Systemic Complications of Plaster Cast

The most serious is deep venous thrombosis leading to pulmonary embolism. Pain in the calf is an important sign needing medical advice.

Immobilization in trunk plasters or plaster beds may also produce nausea, abdominal muscle cramps, retention of urine and abdominal distention.

Good nursing and diet with regular exercises will help ensure that the initial period of extensive immobilization is achieved without complications.

Immediate Local Complications Plaster Cast

Swelling of the Part

A plaster produces constricting effect on the limb and most of it is well tolerated but a moderate constriction will produce compression of the veins, damming the blood, and causing swelling, discomfort or pain, and a blue color in the skin and under the nails.

Temporary remedies such as elevation of the limb and exercising the digits may be tried, but, if persistent, the constriction must be relieved. The cast can be splint and eased or bivalved, taking care not to damage the skin.

Complications of Plastet - Plaster-sore

Impaired Arterial Supply

A pale skin which is cool and without a palpable pulse indicates that the arterial supply is disrupted. If a  pressure on the finger nail  the colour does not immediately return. This is a serious complication. Medical advice must be sought immediately.

Splitting the cast may relieve the arterial compression but sometimes surgery may be necessary.

Incomplete arterial occlusion may present with pain or aching with loss of power. If in doubt ask for medical advice.

Pain

Pain has many causes. This may be due to tissue damage at injury or reduction, swelling within the cast, muscle spasm, pressure on blood vessels or nerves, skin irritation or sores. Although diagnosis may be difficult, persistent pain or intermittent acute pain should not be ignored. Medical advice must be sought.

Delayed Local Complications of Plaster Cast

Plaster Sores

The most common cause of sores is pressure of the plaster on the skin due to poor cast application.

The patient may report burning, itching or stabbing pain.

Children may have disturbed sleep and elevated temperature.

Signs that may suggest plaster sore

  • Heat and swelling of the digits.
  • Increased warmth over a localized area of the cast localized odour
  • Visible pus or staining of the cast.

The most likely reasons for plaster sore development are:

  • Poor technique with adequate padding, or a ridge inside the cast, or failure to trim the ends of the cast correctly.
  • Local cast breakdown with skin irritation due to poor care
  • Foreign bodies may easily slip between the cast and the skin. Children especially may insert small toys, coins or beads while hairgrips may fall inside the cast.
    Patients should be warned of these damages and also to care for the plaster edges since wetting will cause plaster crumbs to be detached and fall inside the cast.
  • Scratching at minor irritation beneath the cast with metal implements or knitting needles may cause trauma and infection. Such irritation should be reported and investigated early.
  • Plaster soakage leading to skin damage and infection
  • Cut edges of plaster following splinting or bivalving or window procedures may irritate the skin especially if swelling occurs around the edge.

Development of plaster sore is very painful. It is a constantly nagging pain that does not leave the patient.The patient is often able to pinpoint the sore area. If patient complains of unrelenting pain or digging sensation the part should be examined.

It should not be ignored at any cost otherwise the results could be disastrous consequences.

A window is cut in the plaster, with an electric cutter. Then underlying padding and lining is removed to inspect the skin.
The skin is examined for any redness or wound.

Grades of Sore

Sores are graded according to depth of the involvement.

  • Grade I-Redness of skin
  • Grade II-Involvement of Subcutaneous Tissue or cellulitis
  • Grade III- Involvement of Muscles
  • Grade IV- Bone Deep

The treatment of sore depends upon the grade. While grade I only requires removal of offending pressure others require treatment that varies from simple dressings to surgical debridement and reconstructive procedures.

The fracture needs to be splinted throughout. In some cases it might be pertinent to shift to external fixation of the fracture.

Apart from immediate complications and plaster sores there are many other problems that can arise with plaster application.

Loss of Position

Because swelling occur with most fractures especially after reduction, the technician puts padding under the cast to protect the skin. This padding gets compressed. After 48 hours when the oedema is subsiding, the cast may be too loose to hold the bone ends in position against undesirable muscle action.

Such displacement may be sudden and cause pain or gradual being first noticed on the next x-ray. This complication may seriously delay sound healing and may produce permanent deformity.

Medical advice must be sought if the position is suspect.

Nerve Damage

Loss of power, tingling and numbness distal to the cast are signs of impaired nerve function. The cause may be direct compression by bone ends or plaster pressure, indirect compression of oedematous tissue or tourniquet effect, or reduced blood flow.

Routine testing of power and sensation will detect any defect quickly. Corrective action includes relieving cast pressure, supporting and protecting paralyzed parts, and physiotherapy to help restore normal function of muscle and joints.

Avoiding The Complications of Plaster Cast

Complications of plaster cast can be reduced by taking all precautions of application of cast, keep a vigilant eye and making sure that patient is well instructed about care of cast.

  • Application of the plaster cast should be done by a skilled person in proper manner
  • Patient, as a routine should always be called for follow up examination next day. Strict elevation of the limb should be instructed.
  • Patient should report on pain that is not relieved, swelling, bluishness or pallor of distal part.
  • Patient should be carefully examined in the follow up for probable complications of plaster cast

 

 

 

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Comments

  1. Ken says

    How long does atrophy take to set in? I will be in a short leg cast for about 8 weeks. but my foot is not at 90 degrees it is pointed almost straight down. the cast covers my toes to just behind the toe nail of my big toe and completely covers my last 2 toes. I have heard this will cause a lot of muscle atrophy in my calf. What can i expect and how long will it take to recover?

  2. Dr Arun Pal Singh says

    @Ken,

    Please talk to your doctor as why it has been applied in that position. may be it is a deliberate on his part due to need for the treatment.

    Untill I know what you have it is very difficult to tell anything about your condition and recovery

  3. Jenny says

    Hello, i fractured my cuboid bone in my left foot followed by my 5th metatasal 2 weeks later whilst in plaster. I have been in plaster now for 3 weeks but i am getting numbness in my little toe and pins and needles in my other toes almost consistently. Is this normal?

  4. ming says

    Hi, i fractured my right lateral malleolus and am in a below the knee fibreglass cast. After 2 days i have been having pain at the site of fracture. Is it normal? The pain score is around 6 out of 10.

  5. Dr Arun Pal Singh says

    @ming,

    Pain at the site of injury is a common experience inspite of immobilization.

    It should become better with passing days.

    Unless it worsens or does not respond to medication, it should be ok.

  6. Laura says

    Hello I've been in plaster for 6 weeks first two weeks non weight bearing then 2 week weight bearing, then when i went back to the hospital the doctor advised me to go back non weight bearing the problem now is Im getting quite severe cramp in my foot is there any suggestions as how to get rid of it i broke my ankle on the 17.12.10 I've not had surgery

  7. Lauren Veenhof says

    my son has a plaster cast on his arm as he has a broken wrist. He has orange like spots on his hand. Is this cause for concern?

  8. Dr Arun Pal Singh says

    @Lauren Veenhof,

    Please show it to your treating doctor. Injury or plaster do not cause this.

    Check out for allergies too.

  9. Dr Arun Pal Singh says

    @Laura,

    Why non weight bearing after a period of weight bearing?

    Any particular reason?

    Your pain killers would relieve you from cramp pain. Take them as advised by your doctor.

  10. Dr Arun Pal Singh says

    @geetha,

    You need to put Ps in front of complications list. Okay! let me see. Can't remember at this moment.

  11. Alison says

    hi i've got a spiral fracture of my 5th metatarsal which was not pinned. My first plaster cast became too loose after about 12 days and I've now had a new one fitted. it was fine at the time but within 12 hours its become very painful at the sight of the fracture and cramping like sensations in my little toe dispite taking tramadol 100mg its still waking me at night.

    Is this normal please? It didn't hurt so much in the last cast

  12. Dr Arun Pal Singh says

    @Alison,

    Though this reply is late for you but the cause of these symptoms might be a tight cast.

  13. Susan says

    I had a complete separation of the EHL tendon. Surgery on Jan. 20, 2012

    casted for 8 weeks , now removed. I cannot move my ankle and the joint beneath my big toe is frozen and painful. What can I expect? when will I be able to move my big toe again?

    thanks

  14. Dr Arun Pal Singh says

    @Susan,

    Gradually with physiotherapy, you should be able to have reasonable function if the repair had been done well.

  15. Craig says

    I have a half leg cast on after breaking my fibula and have been taking CLEXANE injections as advised by the hospital, I am getting severe pains in my calf muscle however and ma struggling to walk on the crutches due to discomfort in my calf muscle, is this common?

  16. ashley eadie says

    Hi i have two fractures in my left knee and was put in a cast from ankle to top of my thigh nearly a week ago. is it normal for the cast to become loose at the top of thigh? I.dont wana.go.back to hosp if its nornal

  17. Diana says

    I rolled my ankle 6-17-12 and have an avulsive fracture to the 5th metatarsal. I have been in a fiberglass cast for 9 days and have been experiencing severe muscle cramps in my calf mostly at night but sometimes during the day also. What can I do to relieve the pain and cramping when it occurs? Is there a way to prevent it? I am normally very active.

    Thank you

  18. Dr Arun Pal Singh says

    @ashley eadie,

    Cast does not remain snug because of shape of thigh but it should become very loose either.

    Your doctor would tell you at follow up if things are okay.

  19. Lauren says

    Hi, I dislocated and fractured my fourth & fifth metatarsals and had reduction surgery 3 weeks ago with wires put in. I had a backslab on for 2 weeks and was then put in a below knee cast. Everything was fine for the first week in the new cast & quite comfortable-could wiggle my toes easily & felt good. Now for the last 3 nights I can't find a comfortable position to sleep as my whole lower leg is going numb. It happens throughout the day as well but not as bad & i seem to be able to change positions to ease the discomfort, but not at night. I can still wiggle my toes & they haven't changed colour or anything but I can't move them as easily as the other week. I did trip on my crutches around the same time this started happening, bearing my full weight on the toes on the bad foot. I went & got an X-ray for this on Monday though & they said it was clear. There's also a bit of pain every now & again, not constant, that I hadn't been getting over the past few weeks. Am I being paranoid & should it just be a little uncomfortable, or should I see if I need the cast changed? Would love to hear your thoughts. Thanks!

  20. Dr Arun Pal Singh says

    @Diana,

    When does cramping occur. Every time or on walking. Has it improved?

  21. Dr Arun Pal Singh says

    @Lauren,

    Everything would be different now from what you have described. How are you?

  22. Charlene says

    Hi , my 10 year old son fell off of the monkey bars on sept 05/2012 at school and I took him to the er and he had broken the elbow it's just above the elbow, we went to the fracture the on sept 06/2012 and the doctor confirm that it was broken , the doctor said he was going to leave my son in the slab cast and that we are to come back on sept 13/2012 to have a X-ray to make sure it's in the right position and then have a full cast put on. My son is having a lot of pin and needle felling in his hand and arm so is this normal for him to be felling this ? Thank u

  23. Diane says

    Hi, I’m 33 and just fractured my ankle my fibula about two days ago my calf keeps getting horrible cramps Charlie horse . ( most excruciating pain of my life 10 on pain scale all i can do is cry until it passes I have yet to see the orthopedic surgeon so I am not in a solid cast my cast is not too tight. What I want to know is how to prevent the cramps. I am very active I run 5 miles a day hike bike and skate. Could it be that my body is not used to being still. How long should I expect to have these cramps?

  24. Dr Arun Pal Singh says

    After a fracture is splinted, the cramps should not occur if the splint is working properly. You should see the doctor again if you are not relieved.

  25. says

    hi, i just got a fractured ankle and i was put on a backslap for a week due heavy swelling on the fractured ankle. after a week swelling shifted to the top of my feet and they put plaster of paris on my ankle and i feel like it is too loose. should i go back so that they can tighten it a bit?

  26. Arun Pal Singh says

    @ Nick,
    With time the plaster does get loose but if it is very loose it might need to be checked and retightened or replaced, depending on the type of plaster.

  27. Bethany says

    Hiya! I’m off to my local hospital hopefully tomorrow due to my cast – again. I have a ‘clinical scafoide break’ according to my dr’s, so I’m in a temp cast right now. Within 12-24 hrs of my cast being put on, I was at my GP to check this cast was on correctly ; 100% thumb movement, cast was loose enough to remove but fingers were squished crossing pinky into next finger, already had discomfort with cast (itchy skin) and was honestly more painful having the cast on then nothing. (I worked for a week with the issue before being put in plaster). My GP said the cast was ‘ok’ but cut off a section around my hand so I wasn’t so impeaded in the fingers and wrapped the top end in a bandage as the cotton was hanging out so much, now I’ve had this one over a week and have had some more issues I’m very worried about.
    I regularly get pins and needles from my elbow down to fingers, swelling so much I’ve woken up thinking my hand is being crushed, the smell is terrible (but I live in Darwin, Australia and it is almost wet-season so over 90% humidity most of the time) and have lost my job because I’m in so much more pain having this thing on my wrist than before. I don’t know what to ask my doctors, or what to look out for but I am at the point (after a week!) I’d rather do physio and put up with the limited pain than have a new cast after the next set of x-rats/ MRI.
    After multiple broken bones this is my first cast and I honesty want to rip it off even if in doing so it causes more damage. It’s that irritating.
    Any ideas what’s wrong?
    Cold air does help help for a few seconds with the itch but I am still pulling out shards of plaster each time.

  28. Arun Pal Singh says

    Your itch problem should be taken care of by use of antiallergic medications. You need the cast yet. Scaphoid fractures take slightly long time to heal and it is very important that it heals. AC, similarly, should take care of humidity or at least make it tolerable.

    I understand that having a cast is not a pleasant experience but it is the treatment that would make you better in due course.

    If you have any specific query, you are most welcome to ask.

    Arun

  29. Anand says

    Hi,
    I am suffering from Jones fracture in left leg. I have been in fibre cast for past 15 days. I am experiencing loosening of cast and small point pain(4/10) in the fracture area.Is it common? I am very careful in not putting weight/ load on the leg.
    Thx & Rgds.

  30. Karen Procter says

    Hi. I sustained an oblique slightly displaced fracture of my 5th metatarsal 4 weeks and 5 days ago, it didn’t need pins or a plate. I was advised to start to weight bear with crutches after 3 weeks and progressively weight bear. Since starting to weight bear the 2 pronounced sharp ridges (above my foot & below my little toe) inside my cast are causing a stabbing pain which is difficult to put up with. I assume a new cast could improve my comfort? Thanks.

  31. Arun Pal Singh says

    Anand,

    The pain would go as the fracture heals more which take s around 4-6 weeks.

    Take care.

  32. Arun Pal Singh says

    Is your cast loose? Why are you contemplating a new cast? Initial pains are common when we put weight on the foot after long time. If these improve with time, it should be fine. Otherewise you should see your doctor which may advise to hold the weight bearing for some time.

    Take care.

  33. guang wei says

    Hello
    I have a cast on due to a fracture at the base of my second martatarsal bone with extension to the TMJ.
    The injury was from 27 december 2014 and its still giving me plenty of prob and i had a cast on since then. i was not able to recognise my leg when it happens, my left foot was crushed. nonetheless the emergency doctors at the hospital concluded i just had 1 fracture at the base of my 2nd left matatarsal bone.
    On 30 december, water slipped into my cast and i return to the clinic to put on a new cast. during the recast, my old cast was taken off and i realise how much the shape of my left foot had changed again.

    compared to my healthy right foot, it is way shorter in length and looks smaller from a general view like it shrink alot
    the width is way bigger as it is swelling very badly. only the heels were not swelling.
    the shape looks much better despite the above 2 factors as the shape of my leg was way too horrendous on the accident day.
    the recast was applied at a very different angle on the left foot. the jelly part of my left foot above the heels hurts if i move around too much always. (i generally hop around my home as i find using crutches a pain.) or fidget on my sit too much. like how someone who wear a undersized shoe. I can guess the jelly part at the back of my left foot is in horrible condition now.

    today marks the 11th day of the accident, 2 days ago, i started experiencing burning sensation in my left foot. The whole left foot. The heels (which were not injured in the first place), the base of my foot, the ankle etc etc.
    often I find myself being waken up by intolerable pain at the back of my left foot. (where the jelly area are.)

    Im kinda worried that the burns will leave scarring marks on my skin or long term skin prob or worsen my injury. Do you think its normal in your point of perspective?

    Thank you doc.

    Also in addition just incase u think its relevant, the injury was sustained when a 1000cc motorcycle, yamaha r1 with flat tyre, fall on my body when i attempt to push the bike to make a u turn at a down slope. the whole weight, (about 180kg) of the bike land on my foot with its left footrest.

  34. Arun Pal Singh says

    Guang Wei,

    If you have persistent burning sensation not relieved by drugs and which is strong enough to wake you up, you should consult your doctor for tightness or impingement of plaster. If patient complains of persistent pain that is not relieved, I usually cut open the cast to see any sore or scar caused by plaster.

    I am not saying that you have it but emphasizing that it is a complaint worth a visit to your treating doctor. Many a times after opening the cast I find normal limb but the patient does get relieved and that itself is worth splitting the cast.

  35. andrea says

    Hello, I have a distal radius fracture, that needed manipulating back into place. Was told had to keep it in split cast for a week and see if it needed operating on. I then went back and had x rays after a week, then doctors said they wanted to keep it in split cast for a further week as they were concerned of bone shortening. Went back again after being in split cast for 2 weeks, doctors said slight shortening and a bit of movement of the bone. They then decided to put it in full cast anyway for 3 weeks and to go back for more x rays. I’m now a week into full cast still getting pain and on the inside of my wrist a sore feeling, also when I do my exercises of the fingers, touching my thumb to each finger and my little finger goes into a sort of spasm, like flicking really bad. Does all this sound ok to you? What I’m concerned with its my prominent hand and long term damage if it’s not delta with now

  36. andrea says

    Hi, I fractured my distal radius 3 weeks ago and having nothing but bother with the cast! I had a split cast on for 2 weeks as bone had to be manipulated back into place, so they was concerned about the bone moving again and shortening. I went back a week ago there was slight movement and shortening but decided to put a full cast on anyway. Had the full cast on for a week and within the first day or so I felt some soreness on the inside of my wrist, so was having to wriggle cast to make it feel a bit more comfortable. A week down the line it’s still sore and no wriggling with prevent this now, just making more pain in the break. It also feels slightly sticky in the sore area. Not sure if this is relevant either but when I do my exercises putting thumb to each finger it sends my little finger into like a spasm, where it flicks really fast.
    Please do you have any advice as to what to do?
    Regards
    Andrea

  37. Arun Pal Singh says

    Andrea,

    You should see your treating doctor if persistent soreness is bothering you. IT becomes prudent to check if there is cast related issue like impingement or sore.

    Better to get it checked.

    Take care.

  38. Humaira says

    Hi, I ended up with two fractures on my left foot after i fell from stairs. Its been six days since i had a cast and I feel pain on/off. As long as I have the foot elevated, it is all good. The only time I feel a lot of pain is when I walk with cruthces. At that time, the finger color also changes, pain is there too but as soon as I elevate it or put it straight on bed, things get okay. I am worried if the cast is too tight or is it normal. Please help!

  39. kaustubh says

    I have a fiberglass cast yesterday and itching has been started yesterday itself.
    Can i get some remedies for itching.

  40. Arun Pal Singh says

    An antiallergy tablet like levocetrizine may help. You can consult your doctor for prescription.

  41. Arun Pal Singh says

    Humaira,

    A tight cast is usually tight in all positions of limb. So it could be the change of position responsible for symptoms. However if symptoms persist, you should see your doctor.How are things now?

  42. Humaira says

    Hey, thank you for your response. Its been three weeks and things are getting pain better as far as pain is concerned. However, i have to keep the foot elevated most of the times. Whenever I put it down, fingers still turn into dark pink but its no longer that painful.

    I hope this is the regular procedure. I’ve read online that as long as elevating your foot is fixing pain, all is well. Is it correct? I still have three weeks to go for my cast removal. How long will it take for me to walk/climb stairs once the cast is removed?

    Thanks :)

  43. jayanta kr. bhattacharyya says

    Dear Doctor,
    I had 2nd & 3rd metatarsal fracture with fracture in lateral malleolus in 29th Dec 2014 without any dislocation. Intial soft POP casting was given for 15 days and thereafter synthetic casting was given for next 5 weeks. Casting was removed on 17th Feb 2015 and I have been allowed for partial wt. bearing, contrast bath and some physiotherapy.I can walk with one elbow crutch and sometime without it but not in normal posture. Swelling is still persisting in foot and ankle area and uneasiness remains throughout although no such unbearable pain is there.Occasionally some pain occurs which fades out while resting the leg a few minutes.

    My question is how much time swelling remain ? Are these symptoms normal ? Please give some suggestions for swelling problem. For your kind information, the consulted Orthopedist opined that everything was fine and reunion occurred.

  44. Arun Pal Singh says

    Humaira,

    I think your treating doctor would be in better position to make those recommendation when you visit him/her. Good to know that things are better now. Take care.

  45. Arun Pal Singh says

    Swelling may stay for many weeks. If the swelling is not present when you get up in the morning, it would go with time. Union has occurred but other blood drainage system takes a longer time to cope up. Observed routinely as part of healing.

    Take care.

  46. Sally says

    I have a displaced fracture 5th metatarsal, had a temp half cast for 5 days and new cast fitted today – now having lots of pain and intermittent numbness of little toe.. Does it need time to settle or is cast too tight?

    Thanks sally

  47. Arun Pal Singh says

    A cast is tight if the problem is persistent or a discomfort that is not relieved by any thing. If it persists, only way to be sure is to open the cast and examine.

  48. usif says

    Hello,
    I have a boxer’s fracture (5th MC just below the pinky). Had a cast for just over a week now. A tiny bit of water slipped into it the other day, not much at all juust a couple of drops is that ok? Also, I have a little bit if a burning sensation under the cast right where my pinky is. Nothing major, just feels more sensitive at times, is that ok? (the padding is a little damp due to sweating). The pain isn’t unbearable it’s just uncomfortable and i’m mostly worried about a sore developing or something like that. (it’s fiberglass). Pain is very manageable.
    thank you

  49. Amit says

    i m having a compressed fractuture in my right hand i m facing blister problem .Dr. had told me to keep the cast for 21 days but in 8 days m facing this kinda problem. its iching

  50. Arun Pal Singh says

    If you have blister, the cast needs to be removed and blister treated. Please see your doctor.

  51. Arun Pal Singh says

    A bit of water would not cause much arm though you should avoid it. Pain could be due to tissue trauma per se. If the pain is persistent or increases in spite of medication, you might get it checked. Sweating is a problem with cast and staying at cooler places would help. Pulling other fingers slightly may help you.

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