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| Complications: (a) Deep Vein Thrombosis(DVT). (b) Blood clotting. (c) Swelling and trauma. (d) Gangrene and skin dryness. |
June 06, 2017
Complications cognate with Plaster and Fiberglass Cast
The plaster of paris or plaster, and Fiberglass casts are widely used conventional methods for the treatment of bone fractures. Few problems and complications are mostly unnoticed during treatment, which lead to several serious complication to the patients. The common complications of plaster and fiberglass casts are stiff joints, muscle wasting and impaired circulation. Physiotherapy and good nursing can help reduce these complications and speed the final recovery.
Complications of plaster cast can be divided into systemic (affects whole body) or local (affects limb), on the basis of where plaster has been applied. whereas local complications of cast can be further classified into immediate and delayed.
Systemic Complications
The most serious is deep venous thrombosis leading to pulmonary embolism, is the formation of a blood clot (thrombus) within a deep vein, commonly the leg veins. Nonspecific signs may include pain, swelling, redness, warmness, and engorged superficial veins. Pulmonary embolism, a potentially life-threatening complication, is caused by the detachment (embolization) of a clot that travels to the lungs. Together, DVT and pulmonary embolism constitute a single disease process known as venous thromboembolism.
Pain in the calf is a most prominent sign of Deep Venous Thrombosis (DVT). Immobilization in trunk plasters or plaster beds may also produce nausea, abdominal muscle cramps, retention of urine and abdominal distention. Good care and balanced diet with regular exercises can ensure that the initial period of extensive immobilization is achieved without complications.
Local Complications
Immediate local complications
Immediate local complication is basically allergic complications of Plaster and Fiberglass cast Material. Though the preservatives and other substances are used to improve under cast skin hygiene, it can be reactive to some of patients with sensitive skin. Allergies can be seen in the form of skin trauma, swelling in fractured part, Impaired Arterial Supply and Pain.
Skin trauma
It is serious and altering physical injury experienced by the skin or multiple layers of epithelial tissues when the limb is allowed to move while the plaster is setting, a ridge forms in the plaster, creating a pressure point on the underlying skin. A ridge commonly forms in the dorsum of the ankle, the popliteal fossa, and the cubital fossa. Complaints of pain or burning must be taken seriously, and the cast must be windowed to inspect painful areas.
Swelling in fractured part
Sometimes if special care is not taken while applying cast, plaster produces constricting effect on the limb and most of it is well tolerated but a moderate constriction will produce compression of the veins, damming the blood, and causing swelling, discomfort or pain, and a blue color in the skin and under the nails which comes in form of swelling to the limbs. In case of higher swelling, casts should be trimmed back to release constricting pressure and examined thoroughly for presence of compartment syndrome. Unnoticed compartment syndrome may leads to very serious consequences such as ischemic injury and necrosis.
Impaired Arterial supply
A pale skin without a palpable pulse indicates that the arterial supply is disrupted. If a pressure on the finger nail the colour does not immediately return, is a serious complication of impaired arterial supply. Medical advice must be taken immediately. Incomplete arterial occlusion may present with pain or aching with loss of power. Splitting the cast may relieve the arterial compression but sometimes surgery may be necessary. If in doubt take medical advice of your doctor.
Pain
Pain may be due to tissue damage at injury or reduction, swelling within the cast, muscle spasm, pressure on blood vessels or nerves, skin irritation or sores. Although diagnosis may be difficult, persistent pain or intermittent acute pain should not be ignored. Medical advice must be taken.
Delayed local complications
Plaster Sores
The most common cause of sores is focal pressure of the plaster on the skin that might be due to improper application of cast. Reason for that may be Poor technique, inadequate padding, or a ridge inside the cast, or failure to trim the ends of the cast correctly or failure to mould cast. The patient may report burning, itching or stabbing pain. Children may have disturbed sleep and elevated temperature. Development of plaster sore is very painful. It is a constantly nagging pain that does not leave the patient.The patient is often able to pinpoint the sore area.
The treatment of sore depends upon the grade of sore. While grade I only requires removal of offending pressure others require treatment that varies from simple dressings to surgical debridement and reconstructive procedures. The fracture needs to be splinted throughout. In some cases it might be pertinent to shift to external fixation of the fracture. Apart from immediate complications and plaster sores there are many other problems that can arise with plaster application.
Loss of Position (reduction)
Due to swelling padding gets compressed which is placed under the cast to protect the skin. After 48 hours when the oedema is subsiding, the cast may loose to hold the bone position against undesirable muscle action. Such displacement may be sudden and cause pain or gradual being first noticed on the next x-ray. This complication may seriously delay sound healing and may produce permanent deformity. Medical advice must be taken if the position is suspect.If the limb is not properly held during the casting procedure, it could also be responsible for malpositioning of fractured ends.
Nerve Damage
Loss of power, tingling and numbness distal to the cast are signs of impaired nerve function. This can cause direct compression by bone ends or plaster pressure, indirect compression of oedematous tissue or tourniquet effect, or reduced blood flow which may lead to nerve damage. Routine testing of power and sensation will detect any defect quickly. Corrective action includes relieving cast pressure, supporting and protecting paralyzed parts, and physiotherapy to help restore normal function of muscle and joints.
Breaking and Softening of the Cast
Breaking and softening of the cast occur due to many reasons such as cast gets wet, persistent pressure on particular area such as the foot or heel, patient fails to take proper care of the cast, and self repair attempts by patients. In case of the breaking of cast, patient must contact the physician for repair or replacement of the cast.
How to avoid Complications
Complications can be reduced by taking precautions during application of cast and making sure that patient is following instructions about care of cast. Careful watch over signs of complications may help patient to react promptly. Patient should be called for routine examination next day and should be carefully examined in the follow up for probable complications of cast.
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