Cast and splint immobilization: complications.

Area of Science:

• Orthopaedic surgery
• Traumatology
• Biomedical engineering

Background:

• Internal fixation is increasingly preferred for fracture management and limb reconstruction over the past 30 years.
• This shift has led to reduced formal training in extremity immobilization and cast application/removal for orthopaedic surgeons.
• Casting, while common, carries risks such as stiffness, pressure sores, and compartment syndrome, with higher morbidity associated with less experienced practitioners.

Purpose of the Study:

• To highlight the importance of proper cast and splint application techniques.
• To recommend specific materials and methods for ideal cast and splint application.
• To prevent patient morbidity, particularly in high-risk individuals.

Main Methods:

• Review of current practices in fracture management and limb reconstruction.
• Analysis of risks and complications associated with casting.
• Identification of patient populations at high risk for casting complications.
• Formulation of recommendations for materials and methods in cast/splint application.

Main Results:

• Less formal instruction in casting techniques is provided to orthopaedic surgeons in training.
• Casting complications can be severe, and their incidence is higher with less experienced surgeons.
• Specific patient groups (obtunded, comatose, anesthetized, very young, developmentally delayed, spastic) are at increased risk.

Conclusions:

• Ideal cast and splint application methods are recommended to minimize morbidity.
• Preventive strategies are essential for high-risk patients undergoing casting or splinting.
• Ensuring proper technique is vital for patient safety in extremity immobilization.