Revolution in orthopedic immobilization materials: A comprehensive review

Immobilization material has slowly revolutionized since 3000 BCE from traditional plaster to modern day synthetic casting tape, including other sustainable immobilization material. This revolution is driven by the search for superior casting material that possesses excellent mechanical and load-bearing properties, non-toxicity, excellent healing rates, patient satisfaction and eco friendliness. Even though the new materials have been evolved, the traditional plaster still remains a material of choice owing to its excellent skin conformability, low cost and availability. This paper aims to present a comprehensive review on the technique of immobilization, existing orthopedic immobilization (casting and splinting) materials and complications associated with immobilization (mainly casting) which aimed to assist the medical practitioners and researchers in casting material improvements and selection. Nine immobilization materials are comprehensively discussed for their desirable properties, drawbacks and the required improvements to the composition, along with the most common cast complications ranging from superficial pressure sores to compartment syndrome and Deep Vein Thrombosis. . This paper identifies that among the existing material, plaster casts are still highly used due to their cost benefit and the ability to fit patients into full body casts, while synthetic material is too rigid and has a higher probability of causing complications such as compartment syndrome and deep vein thrombosis. Patients show a higher preference in using synthetic casts for short term and body extremity casting as they are comparatively more comfortable. New materials such as Woodcast shows good promise but their mechanical characteristics and comfort are yet to be critically analyzed. However, there exists an imminent requirement to upgrade existing material as well as to introduce novel promising sustainable material for long term immobilization.