Complications Associated With Plaster Application

Generally speaking, if one is watchful enough, the treatment with plaster cast application is quite safe procedure. But there are few complications associated which needs to be watched. Here is the list-

Impaired Venous Circulation

A moderate constriction will produce compression of the veins, damming the blood, and causing swelling, discomfort or pain, and a blue colour 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 pulseless indicates that the arterial supply is disrupted; following 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 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

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.

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.

Diagnosis is achieved by looking for:

• 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.
• Inadequate instructions to the patient may lead to local cast breakdown with skin irritation.
• Inadequate supervision by orthopaedic staff such as failing to take corrective action at the first sign of skin irritation or cast loosening.
• 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.
• Cut edges of plaster following splinting or bivafving or window procedures may irritate the skin especially if swelling occurs around the edge. If a window is not replaced the tissue is likely to become oedematous and balloon through the window causing sores. The problem is accentuated in a load bearing plaster which may also be seriously weakened.