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.
Local Complications
Encasement of the limb or trunk in plaster may produce stiff joints, muscle wasting and impaired circulation. Physiotherapy and good nursing can help reduce these complications and speed the final recovery.
Systemic Complication
The most serious is deep venous thrombosis leading to pulmonary embolism. Pain in the calf is an important sign needing medical advice.
Immobilisation 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.
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 Reply:
August 8th, 2010 at 9:16 pm
@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
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?
Dr Arun Pal Singh Reply:
September 2nd, 2010 at 6:42 am
@Jenny,
Usually it does not occur. You might want to check if the cast is too tight.
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 Reply:
January 7th, 2011 at 2:13 am
@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.
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 Reply:
February 4th, 2011 at 7:46 am
@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.
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 Reply:
February 4th, 2011 at 7:44 am
@Lauren Veenhof,
Please show it to your treating doctor. Injury or plaster do not cause this.
Check out for allergies too.
which are the 5 p complications of plaster of cast,
Dr Arun Pal Singh Reply:
March 31st, 2011 at 12:50 pm
@geetha,
You need to put Ps in front of complications list. Okay! let me see. Can’t remember at this moment.
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 Reply:
May 28th, 2011 at 1:48 pm
@Alison,
Though this reply is late for you but the cause of these symptoms might be a tight cast.
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 Reply:
April 18th, 2012 at 11:34 pm
@Susan,
Gradually with physiotherapy, you should be able to have reasonable function if the repair had been done well.