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?

    • 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

  2. 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?

  3. 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.

    • 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.

  4. 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

    • 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.

  5. 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?

    • 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.

    • 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.

  6. 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

    • Dr Arun Pal Singh says

      @Alison,

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

  7. 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

    • Dr Arun Pal Singh says

      @Susan,

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

  8. 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?

  9. 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

    • 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.

  10. 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

  11. 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!

  12. 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

  13. 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?

    • 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.

  14. 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?

    • 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.

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