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.
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 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
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.
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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