You have been given a (plastic) cast at the emergency department. This leaflet informs you about how to treat it, what you should take account of when moving the (plastic) cast, what to do in case of complaints and where you can turn for questions.
The cast
You have been given a cast around your arm or leg. A plaster or plastic cast ensures that the limb in the cast gets rest and can no longer move. In case of, e.g., a bone fracture, the cast ensures that the bones stay in the right position and can heal in case of a damaged joint or tendon; it ensures that these can rest.
Below are several tips:
Sturdiness:
Plaster isn’t hard until after 48 hours, so you have to be careful with it for the first two days. Don’t let the plaster cast rest on a hard edge, but on a soft base. Circular plastic casts are completely hard after 30 minutes, so you don’t need to be careful for very long.
Plaster and water:
Plaster isn’t allowed to get wet. Circular plastic casts can take water, but the cotton cover and pads underneath can’t. It’s therefore best to protect the plaster or plastic cast with a plastic bag or a special bath cover when taking a shower. A plastic bag can be made watertight using a plaster on the skin. A special shower cover can be obtained from home care. You have to pay for it as health insurance companies usually don’t reimburse it. Shower as quickly as possible.
Keep your arm or leg up:
Especially in the first week it is important that you keep your cast arm or leg up to ensure that the swelling decreases and to prevent the swelling from getting worse. Make sure the injured part of your body is higher than the rest of the body. If your arm is swollen, wear it in a sling or place the arm on a cushion on the table. Make sure your hand is higher than the elbow. You can take off the sling at night and, if you want, rest it on a pillow/cushion. You may not wear rings or bracelets during the whole cast period as these can pinch if a light swelling occurs. You can check your circulation on the basis of the colour of the nails, so don’t wear nail polish. If your leg is swollen, place it on one or more cushions. It’s important that the foot is higher than the knee and the knee is higher than the hip. You can raise your leg at night by lifting the foot of your bed by placing a cushion under the mattress. It’s best not to walk too much (with your crutches) because the leg then hangs down for a long time.
Dystrophia
Serious signals in case of persistent swelling are redness or shiny skin, where the pain doesn’t decrease considerably. In the common recovery process, complaints reduce within 10 days. If this isn’t the case, please make an appointment with the hospital. An examination is then required to exclude or determine the beginning of dystrophia. Dystrophia is a disorder that can occur after an injury or surgery on an arm or leg. In this disorder all tissues can become involved and this can be indicated by an abnormally strong reaction of the body to an injury or operation. If dystrophia is discovered and treated on time, it can be cured without any remaining symptoms.
Exercises:
It’s important that you exercise to stimulate blood circulation, keep uncast joints supple and preserve muscle strength as much as possible. Try the following exercises a few times a day and repeat five times.
Arm exercises
Stretch and bend the elbow if it isn’t in a cast.
Turn circles with the shoulder.
Make a fist, count to three and then stretch the fingers.
Leg exercises:
While seated, lift the stretched leg for three counts.
If the knee is not plastered: bend and stretch the knee.
Pull the toes towards you (towards your nose) for three counts, then push away from you for another three counts.
Elbow crutches:
You are not allowed to place a load on a plaster splint, because it will break. You may therefore not walk or stand without using crutches. If the doctor said you could, then you may place a load on circular plaster casts and plastic casts. You will be given verbal instructions. You can hire crutches in the hospital. You can go to the Patienten Service Bureau on weekdays from 9.00 am-12.00 pm and from 1 pm-4 pm, and at the reception outside opening hours.
Walking plaster cast:
If the doctor allows a load to be placed on the plaster cast, you will get a walking plaster cast. If you have a walking plaster cast, ensure that you don’t start to drag the plastered leg. Try to walk as normal as possible. As you cannot use your ankle, you need to take small steps. Generally, a sole is attached under the walking plaster cast, which you can remove when you go to bed. This sole is often thicker than that of your shoes. To ensure that this doesn’t bother you when waking, you can wear a shoe on the non-plastered leg with a sole or heel of similar thickness or height. With a walking plaster cast you have to support your leg when you sit. You can do this, for instance, by putting your leg on a stool. This prevents swelling.
Itch and skin damage:
Itch is usually caused by moisture between the skin and the plaster cast. If you start to suffer from itch, you can counteract this by carefully blow drying the space between the skin and the plaster cast (please note: not too hot because of the risk of burning!). You can also get special anti-itch spray for plaster casts from your pharmacy. In any case, don’t use sharp objects such as knitting needles to get rid of the itch as this can cause serious skin damage. Skin damage can also be caused by small objects ending up between the plaster and your skin. Especially young children tend to hide toys in the plaster.
Measures against thrombosis:
If your leg is in a cast, you move less. This increases the chance of thrombosis (clotting of the blood). The risk is increased in case of varicose veins, pregnancy and people with little mobility. This is why the doctor who is treating you can prescribe blood-diluting medicine. This is done in the form of injections under the skin. You can learn to inject yourself or get home help for this.
Pain:
In case of pain you can use Paracetamol. The dose depends on your weight. See instructions.
Important
Take account of the fact that you cannot drive with the plaster cast, because you are not insured. For this you can contact your car insurance company
If you have circular plaster (plaster cast all around a limb) you may not fly.
If you are going to fly anyway, it’s wise to find out the rules from the airline company in question. Flying with a plaster cast is a decision you take at your own responsibility.
When to contact us
Contact us by phone if, in spite of raising your leg or arm:
Your fingers or toes start to tingle, become numb, thicken or turn purple-blue.
You cannot or barely move your fingers or toes.
The plaster cast causes pain or pinches (pain at the location of the fracture is usually not alarming).
Your plaster cast is broken. In case of a walking plaster cast you may then no longer place a load on it.
Your plaster cast has become wet and weak.
Removing the plaster cast
If you come to the hospital because the lower leg plaster cast can be removed after a period of treatment, then we recommend taking a shoe with laces or another sturdy shoe with you, as you will probably be allowed to walk again. When removing a circular or plastic cast from the leg it is important that you take your elbow crutches with you, because there is a big chance that your muscles and joints have become stiff after a plaster cast treatment and you have trouble walking or are not allowed to walk on the injured leg. Shortly after removing a circular or plastic cast of the leg there may be some swelling of the leg. To prevent this, you will be given an elastic stocking. This applies to the arm for a lesser extent. If swelling occurs after removing the plaster cast, this will increase during the course of the day and will be strongest at night. This is nothing to worry about, the swelling will disappear after some time. You can reduce complaints by not placing too much load on the leg or arm and raising it during the day or wearing an elastic stocking (take this off at night).
Making an appointment
During the first checkup the plaster caster and the surgeon will discuss the follow-up policy. The doctor’s assistant will contact you to plan a follow-up appointment.
Apology for absence
It’s important that you are on time. If you cannot make it, please let the outpatient surgery or orthopaedic outpatients know asap.
Questions
If you have any questions related to this leaflet, please contact the outpatient surgery or orthopaedic outpatients. The outpatient surgery can be reached from Monday to Friday from 8.30 am-4.30 pm. T +31 (0) 187 60 71 10 The orthopaedic outpatientscan be reached from Monday to Friday from 8.30 am-4.30 pm. T +31 (0) 187 60 71 16 For urgent matters outside office hours, contact the emergency department (SEH). T +31 (0) 187 60 72 90
Reimbursement of hospital care
Not all hospital care is reimbursed by your insurance company. You also always pay the deductible. Ask your insurance company in advance whether your visit and/or treatment in the hospital are reimbursed. More information can be found on our website under ‘costs and reimbursements’ and on www.dezorgnota.nl.
Source
Arm of been in het gips, Onze Lieve Vrouwe Gasthuis (OLVG) in Amsterdam www.olvg.nl/afdelingen/gipskamer consulted February 2017.
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