COMPLICATION OF POPSYSTEMIC COMPLICATIONSDVT LEADING TO
PEIMMOBILISATION IN TRUNK PLASTER-NAUSEA, ABDOMINAL CRAMPS, URINARY
RETENTION, ABDOMINAL DISTENSIONTIGHT CAST-D/T PUT ON TIGHTLY OR
BECOME TIGHT IF LIMB SWELLS- DIFFUSE PAIN, OR SIGNS OF VASCULAR
COMPRESSION(PALE, LOSS OF POWER)-NEED TO SPLIT CAST(OR BIVALVE) AND
ELEVATE LIMB-WHENEVER EXPECT SWELLING, CAST TO BE APPLIED OVER
THICK PADDING AND PLASTER SPLIT BEFORE IT SETS -PAIN , COMPARTMENT
SYNDROME, PERIPHERAL NERVE INJURYPAINtissue damage at injury or
reductionswelling within the castmuscle spasmpressure on blood
vessels or nervesskin irritation or sores. DELAYED
COMPLICATIONSPRESSURE SORELOSS OF POSITIONNERVE INJURYPRESSURE
SORES-WELL FITTING CAST MAY PRESS UPON SKIN OVER BONY
PROMINENCE(PATELLA, HEEL, ELBOW, OR HEAD OF ULNA)-COMPLAINTS OF
LOCALISED PAIN NEEDS IMMEDIATE INSPECTION THROUGH A WINDOW
CASTSIGNS-BURNING, ITCHING, STABBING PAIN-HEAT AND SWELLING OF
DIGITS-INCREASED WARMTN OVER A LOCALISED AREA OF THE CAST-VISIBLE
PUS OR STAINING OF THE CAST
WHY?Poor technique with adequate padding, or a ridge inside the
cast, or failure to trim the ends of the cast correctly.Local cast
breakdown with skin irritation due to poor careForeign bodies may
easily slip between the cast and the skin. Children especially may
insert small toys, coins or beads while hairgrips may fall inside
the cast.Patients should be warned of these damages and also to
care for the plaster edges since wetting will cause plaster crumbs
to be detached and fall inside the cast.Scratching at minor
irritation beneath the cast with metal implements or knitting
needles may cause trauma and infection. Such irritation should be
reported and investigated early.Plaster soakage leading to skin
damage and infectionCut edges of plaster following splinting or
bivalving or window procedures may irritate the skin especially if
swelling occurs around the edge.
Grades of SoreSores are graded according to depth of the
involvement.Grade I-Redness of skinGrade II-Involvement of
Subcutaneous Tissue or cellulitisGrade III- Involvement of
MusclesGrade IV- Bone Deep
LOSS OF POSITIONswelling occur with most fractures especially
after reduction the technician puts padding under the cast to
protect the skin This padding gets compressed After 48 hours when
the oedema is subsiding, the cast may be too loose to hold the bone
ends in position against undesirable muscle action.Such
displacement may be sudden and cause pain or gradual being first
noticed on the next x-rayThis complication may seriously delay
sound healing and may produce permanent deformity.
NERVE DAMAGELoss of power, tingling and numbness distal to the
castThe cause may be direct compression by bone ends or plaster
pressure, indirect compression of oedematous tissue or tourniquet
effect, or reduced blood flow.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.
SKIN ABRASION OR LACERATION-COMPLICATION WHILE REMOVING
PLASTERS-COMPLAINTS OF PINCHING OR NIPPING
IMPROPER APPLICATIONJOINT STIFFNESSBLISTERS AND
SORESBREAKAGELOOSE CAST-ONCE SWELLING SUBSIDES, NEED TO BE
REPLACEDALLERGIC DERMATITISAVOID COMPLICATIONApplication of the
plaster cast should be done by a skilled person in proper
mannerStrict elevation of the limb should be instructed.Patient
should report on pain that is not relieved, swelling, bluishness or
pallor of distal part.Patient should be carefully examined in the
follow up for probable complications of plaster cast
