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SKILLS - ASSESSMENT OF A LIMB IN A CAST

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Abstract

VOL: 99, ISSUE: 31, PAGE NO: 27

 WHY ARE CASTS USED?

- To support/control movement of bone fragments following fracture.

- To stabilise and rest joints following ligament injury.

- To support and immobilise joints and limbs postoperatively.

- To correct deformities by the use of serial casts.

TYPES OF COMPLICATION

- Circulatory/nerve impairment.

- Pressure/cast sores.

- Skin laceration from rough plaster edges.

- Allergic reaction, usually caused by the inner padding of cast.

SIGNS AND SYMPTOMS

- Circulatory and nerve impairment.

- Arterial compression: pallor or cyanosis of limb extremities. Limited and painful movement of digits.

- Venous compression: excessive redness, pain and/or swelling.

- Nerve compression: ‘pins and needles’ sensation leading to numbness, limited movement and pain in limb.

- Compartment syndrome: pain out of proportion to trauma/procedure. Increased pain on passive movements. Signs of circulatory/nerve compression.

- Deep vein thrombosis (DVT): calf pain, heat, swelling.

SORES/LACERATION/ALLERGY

- Pressure/cast sores: localised burning pain directly over affected area. Numbness if tissues become ischaemic. Local area of heat on plaster. Swelling of digits. Offensive smell with necrotic tissue. Visible discharge staining on plaster.

- Laceration: broken skin, redness and pain around edges of plaster cast.

- Allergy: itching, localised burning, rash, skin blistering.

TYPES OF ASSESSMENT REQUIRED

- Colour.

- Movement.

- Sensation.

- Pain scoring. 

- Swelling.

- Radial/pedal pulse.

- Wound staining/oozing through plaster postsurgery/open trauma.

- Temperature: raised temperature may indicate a wound infection.

- Blood pressure and pulse: hypotension and tachycardia (plus blood staining through plaster) may indicate haemorrhage from wound.

MANAGEMENT CONSIDERATIONS

- Circulatory and nerve impairment.

- Elevate limb. If symptoms persist splitting the cast throughout its length bivalve (into an anterior and a posterior half) will relieve pressure by 50-85 per cent (Phillips, 1992). Prophylactic antithrombotic agent to prevent DVT. If DVT is suspected then enzyme-linked immunosorbent assay (ELISA) D-dimer test (Michiels et al, 2000)

- Pressure/cast sores: inspection window cut in plaster, caution is required as this may result in tissue herniation through the hole (Charnley, 1999). Plaster removal may be indicated.

- Laceration: trimming of plaster edges.

- Allergy: previous history of allergies should be noted; plaster removal is indicated (Davies, 2000).

FURTHER INFORMATION

- Loose cast: once swelling subsides, cast may no longer hold fracture securely and may need replacing.

- Patient empowerment: involve the patient to participate actively in his or her own care and alert staff to potential problems (Davies, 2000).

WEBSITE

Great Ormond Street Hospital for Children NHS - looking after your child’s plaster cast: www.ich.ucl.ac.uk/factsheets/misc/plaster_cast

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