Orthopaedic Surgery - Essential instructions for casts

Please read the following instructions carefully.

All rings must be removed before the cast is applied and must remain off until your cast is removed.

If you experience any of the following you must report to the hospital you originally attended or go to your nearest Accident and Emergency department/Urgent Care Centre immediately:

• Your cast becomes tight
• Your toes or fingers become blue or swollen
• You are unable to move your limb
• Your limb becomes more painful or tender
• You feel ‘pins and needles’ or numbness
• You have discharge, wetness or smell under the cast
• You drop any object down inside the cast
• You have any blister-like pain or rubbing under the cast - you must contact the Plaster Room or Urgent Care Centre, even if the pain subsides
• Your cast becomes loose or cracks

Care Dos and Don'ts

Dos:

• DO seek urgent advice or attention if you experience any of the issues listed previously
• DO exercise your joints not held in the cast as much as possible
• DO allow the cast to dry naturally. If it is made of Plaster of Paris, leave it uncovered for 24 hours
• DO support your limb and cast with a pillow in a raised position when sitting in a chair

Don'ts

• DO NOT let your limb hang down unless it is being used. You must elevate the limb in plaster cast as advised to do so by the hospital staff, especially during the first few days to allow swelling to subside
• DO NOT use artificial methods to dry it, such as sitting near the fire, as your cast may become hot and burn you
• DO NOT wet the cast, it may disintegrate or cause skin problems
• DO NOT cut, heat or otherwise interfere with your cast if the cast becomes cracked, soft, loose or tight

If you have any concerns at all please contact the plaster room on the site where you were originally seen:

Fairfield General Hospital:
Telephone Number: 0161 778 2896
Monday to Thursday 8.30am to 5pm, Friday 8.30am to 1pm

Rochdale Infirmary:
Telephone Number: 01706 517320
Monday to Thursday 8.30am to 5pm, Fridays 1.30pm to 5pm

The Royal Oldham Hospital:
Telephone Numbers: 0161 778 5988 or 0161 627 8886
Monday to Thursday 8.30am to 5pm, Fridays 8.30am to 1pm

The Casting Technicians can offer advice and make arrangements for you to be seen or will advise you to attend you local Accident and Emergency Department for advice.

Risks associated with having a limb in a cast

The two main risks are Pressure Ulcers and Deep Vein Thrombosis:

Pressure Ulcers

These can be acquired through the cast continually rubbing or being too tight over more vulnerable areas of the body such as ankle bones, heel bones and elbow joints.

The cast is padded out in a specific way to avoid these complications, but where the cast slips, or is misused, such as putting weight through it when this is not advised, can contribute to the development of these.

Symptoms of the development of Pressure Ulcers are listed at the beginning of this leaflet, but you must take due care of your cast and follow any instructions given to you by clinical staff, including these.

Deep Vein Thrombosis (DVT)

Whenever we cut ourselves, our blood hardens and a scab forms. This process is called blood clotting or coagulation. One of the risks of limited and restricted movement associated with your casts can be that a clot can occur within a vein, forming a 'plug' that can interrupt the normal flow of blood through the blood vessels.

When this happens in a deep vein this is referred to as a Deep Vein Thrombosis and called 'DVT' for short.

The blood clot itself is not life threatening, but if it breaks away it can be carried in your blood stream to another part of your body such as the lungs which is called a pulmonary embolus (PE for short and can be fatal).

Signs and Symptoms to look out for:

If you experience any of the following after having your plaster cast put on you must report to the hospital you originally attended or go to your nearest Accident and Emergency Department immediately:

• Shortness of breath that you have not experienced before
• Chest pain, which may become worse on inhalation (breathing in)
• Swelling of your limbs
• Discolouration of your toes or fingers
• Limbs more painful or tender to touch
• The veins on your affected limb appear larger than normal and you notice them more
• There is an offensive smell coming from the cast
• If you have any significant pain or discomfort if you are told to weight bear (walk)

If you are going on holiday and wish to fly whilst in a cast, then please ask for medical advice.