Casting acute fractures. Part 1--Commonly asked questions

Correct splinting of acute fractures offers comfort and is often the definitive treatment for many simple injuries. The use of a cast is a common method of splinting. The best methods for application of casts and their rationale are poorly understood by many doctors and not detailed well in standard texts.

This series will attempt to address some common initial casting techniques suitable for general practice. Specific time and cost saving manoeuvres will be given. Common pitfalls will be identified.

The primary care physician traditionally applies the first cast. This coincides with the time of greatest risk as fractures are potentially unstable, and swelling is often anticipated rather than actually present. The swelling and associated morbidity from a cast can be considerable. Optimising comfort, function and safety in the initial cast is multifactorial. Attention to these factors gives a far better short and long term outcome for the patient. This also reduces medicolegal risk and the cost of unplanned return visits due to unnecessary morbidity.