Pediatric orthopedic cast types and maintenance instructions

Why does my child need a pediatric orthopedic cast?

If your child suffers a fracture, a physician will apply a cast to foster the healing of the broken bone. A cast will hold the broken bone in place. Casts also help prevent or decrease muscle contractions and are effective at immobilizing the area of the break, especially after surgery.

A fracture is a partial or complete break in a bone. It occurs when more force is applied to a bone than it can absorb. Your child could suffer a bone break from a fall or trauma, or as a result of a direct blow to the body. A bone break can be an open fracture (also called a compound fracture), where the bone is visible through the skin, or it can be a closed (or simple) fracture where the skin remains intact.

What is a pediatric orthopedic cast?

The outside, or hard part of cast, is made from two kinds of materials: plaster or fiberglass. Cotton and other synthetic materials line the inside of cast, making it soft and providing padding around bony areas, such as the wrist or elbow. Waterproof cast liners may be used under a fiberglass cast, allowing the child to get the cast wet.

Casts also can be used to immobilize the trunk of the body and one or more limbs. These are called spica casts.

Each serves a specific purpose – for instance, to hold the hip muscles and tendons in place after surgery to allow for proper healing – and they offer several options:

• Unilateral hip spica cast (applied from the chest to the foot on one leg for thigh fractures)

• One-and one-half hip spica cast (applied from the chest to the foot on one leg to the knee of the other leg)

• Bilateral long leg hip spica cast (applied from the chest to the feet)

• Short leg hip spica cast (applied from the chest to the thighs or knees)

• Shoulder spica cast (applied around the trunk of the body to the shoulder, arm and hand)

One other type, a Minerva cast, is applied around the neck and trunk of the body after surgery on the neck or upper back area.

What are the different types of pediatric orthopedic cast types?

Cast types fall into two primary types - upper extremity and lower extremity.

1. Upper extremity

   • Short arm cast – applied below the elbow to the hand for forearm or wrist fractures or to hold the forearm or wrist muscles and tendons in place after surgery

   • Long arm cast – applied from the upper arm to the hand for upper arm, elbow or forearm fractures or to hold the arm or elbow muscles and tendons in place after surgery

   • Arm cylinder cast – applied from the upper arm to the wrist to hold the elbow muscles and tendons in place after a dislocation or surgery

   • Shoulder spica cast – applied around the trunk of the body to the shoulder, arm and hand for shoulder dislocations or after surgery on the shoulder area

   • Minerva cast – applied around the neck and trunk of the body after surgery on the neck or upper back area

2. Lower extremity

   • Short leg cast – applied to the area below the knee to the foot for lower leg fractures, severe ankle sprains/strains or fractures, and to hold the leg or foot muscles and tendons in place after surgery to allow healing

   • Leg cylinder cast – applied from the upper thigh to the ankle for knee or lower leg fractures, knee dislocations, or after surgery on the leg or knee area

   • Unilateral hip spica cast – applied from the chest to the foot on one leg for thigh fractures and to hold the hip or thigh muscles and tendons in place after surgery to allow healing

   • One-and-one-half hip spica cast – applied from the chest to the foot on one leg to the knee of the other leg. A bar is placed between both legs to keep the hips and legs immobilized. It is used for thigh fractures or to hold the hip or thigh muscles and tendons in place after surgery to allow healing.

   • Bilateral long leg hip spica cast – applied from the chest to the feet. A bar is placed between both legs to keep the hips and legs immobilized. It is used for pelvis, hip or thigh fractures or to hold the hip or thigh muscles and tendons in place after surgery to allow healing.

   • Short leg hip spica cast – applied from the chest to the thighs or knees to hold the hip muscles and tendons in place after surgery to allow healing

   • Abduction boot cast – applied from the upper thighs to the feet. A bar is placed between both legs to keep the hips and legs immobilized. It is used to hold the hip muscles and tendons in place after surgery to allow healing.

How do I care for my child's orthopedic cast?

As a parent, you’ll need to oversee the care of the cast to avoid re-injury, discomfort or infection.

This means:

• Keeping your child’s cast clean and dry

• Checking for cracks or breaks in the cast

• Refraining from putting powders or lotions inside the cast

• Covering the cast while your child is eating (to prevent spills and crumbs from entering the cast)

• Encouraging your child to move his or her fingers or toes to promote circulation

• Discouraging your child from inserting objects under the cast to scratch the skin

If itchiness becomes a problem, you can use a hair dryer placed on a cool setting to blow air under the cast and cool down the hot, itchy skin. If your child is in a body cast, you may need to provide him or her with a bedpan or portable urinal.

Here are some other care tips:

• Rough edges of the cast can be padded to protect the skin from scratches.

• Elevate the cast above the level of the heart to decrease swelling.

• Do not use the abduction bar on the cast to lift or carry the child.

• Keep body casts clean and dry to prevent skin irritation around the genital area.

Often, your child will be given assistive devices while his body area is immobilized.

These include:

• Crutches (crutch walking)

• Walkers

• Wagons

• Wheelchairs

• Reclining wheelchairs

Problems with casts sometimes arise. These may need the intervention of a physician. Call your doctor if you see that your child has a fever greater than 101° F (38.3° C) or is suffering increased pain.

Other red flags include:

• Increased swelling above or below the cast

• Complaints of numbness or tingling

• Drainage or foul odor from the cast

• Cool or cold fingers or toes