orthopedic cast orthopedic cast an orthopedic cast, or simply cast, is a shell, frequently made from plaster or fiberglass, that encases a limb (or, in some cases, large portions of the body) to stabilize and hold anatomical structures—most often a broken bone (or bones), in place until healing is confirmed. it is similar in function to a splint. orthopedic casta short leg cast with a fibreglass top layer being used to treat a fractured foot.other namesbody casts, plaster cast, surgical cast plaster bandages consist of a cotton bandage that has been combined with plaster of paris, which hardens after it has been made wet. plaster of paris is calcined gypsum (roasted gypsum), ground to a fine powder by milling. when water is added, the more soluble form of calcium sulfate returns to the relatively insoluble form, and heat is produced. 2 (caso4·½ h2o) + 3 h2o → 2 (caso4.2h2o) + heat the setting of unmodified plaster starts about 10 minutes after mixing and is complete in about 45 minutes; however, the cast is not fully dry for 72 hours. current bandages of synthetic materials are often used, often knitted fiberglass bandages impregnated with polyurethane, sometimes bandages of thermoplastic. these are lighter and dry much faster than plaster bandages. however, plaster can be more easily moulded to make a snug and therefore more comfortable fit. in addition, plaster is much smoother and does not snag clothing or abrade the skin. cast types upper extremity short arm cast on a child. upper extremity casts encase the arm, wrist, or hand. a long arm cast encases the arm from the hand to about 2 inches below the armpit, leaving fingers and thumbs free. a short arm cast, in contrast, stops just below the elbow. both varieties may, depending on the injury and the doctor's decision, include one or more fingers or the thumb, in which case it is called a finger spica or thumb spica cast. lower extremity newly applied short leg cast short leg walking cast lower extremity casts are classified similarly, with a cast encasing both the foot and the leg to the hip being called a long leg cast, while a cast encasing the patient's foot, ankle and lower leg ending below the knee is referred to as a short leg cast. a walking heel may be applied for ambulation. these heels, when properly applied, elevate the toes and offer the wearer the advantage of keeping the toes out of the dirt and moisture of the street. the walking heel provides a small contact patch for the cast and creates a fluid rocking motion during the stride as the cast can pivot easily in any direction. similarly, a weight-bearing cast shoe (cast boot, cast sandal) can help the patient walk during convalescence. additionally, a castshoe can simply protect the patient's casted foot while helping to maintain better hygiene by preventing the cast from directly contacting potentially dirty or wet ground surfaces. where the patient is not to walk on the injured limb, crutches or a wheelchair may be provided. the foot's under-sole portion of a leg cast may be extended terminating at the tip of the patient's toes, to create a rigid support that limits motion of the metatarsals in both weight bearing and non-weight bearing leg casts. these are referred to as toeplates in the orthopedic discipline of medicine. this addition may be applied to further support and stabilize the metatarsals by limiting motion through a higher degree of immobilization, as well as protecting the toes from additional blunt force trauma. typically leg casts with no toeplate are prescribed for injuries to the foot and metatarsals. ordinarily, a leg cast applied for the treatment of a stable ankle fracture would not use the toeplate design because there is no need to immobilize and limit the motion of the patient's toes. cylinder in some cases, a cast may include the upper and lower arm and the elbow, but leave the wrist and hand free, or the upper and lower leg and the knee, leaving the foot and ankle free. such a cast may be called a cylinder cast. where the wrist or ankle is included, it may be called a long arm or long leg cast. body body casts, which cover the trunk of the body, and in some cases the neck up to or including the head (see minerva cast, below) or one or more limbs, are rarely used today, and are most commonly used in the cases of small children, who cannot be trusted to comply with a back brace, or in cases of radical surgery to repair an injury or other defect. a body cast that encases the trunk (with "straps" over the shoulders) is usually called a body jacket. these are often very uncomfortable. edf cast an edf (elongation, derotation, flexion) cast is used for the treatment of infantile idiopathic scoliosis. this method of treatment for correction was developed by uk scoliosis specialist min mehta. scoliosis is a 3-dimensional problem that requires correction in all three planes. the edf casting method can elongate the spine through traction, derotate the spine/pelvis, and improve lordosis and overall body shape and alignment. edf differs from risser casting. edf casts are either over or under the shoulder, and have a large mushroom opening on the front to allow for proper chest expansion. on the back, there is a small cutout on the concavity of the curve, not going past the midline. it was found that the spine became more aligned with this cutout than without, and that it helped correct rotation. spica cast a cast that includes the trunk of the body and one or more limbs is a spica cast, just as is a cast that includes the "trunk" of the arm and one or more fingers or the thumb. for example, a shoulder spica includes the trunk of the body and one arm, usually to the wrist or hand. shoulder spicas are almost never seen today, having been replaced with specialized splints and slings that provide early mobility of the injury to avoid joint stiffness after healing. a hip spica includes the trunk of the body and one or more legs. a hip spica that covers only one leg to the ankle or foot is called a single hip spica, while one that covers both legs is a double hip spica. a one-and-a-half hip spica encases one leg to the ankle or foot and the other to just above the knee. the extent to which the hip spica covers the trunk depends greatly on the injury and the surgeon; the spica may extend only to the navel, allowing mobility of the spine and the possibility of walking with the aid of crutches, or may extend to the rib cage or even to the armpits in some rare cases. hip spicas are common in maintaining reduction of femoral fractures and are also used for congenital hip dislocations, mostly while the child is still an infant. in some cases, a hip spica may only extend down one or more legs to above the knee. such casts, called pantaloon casts, are occasionally seen to immobilize an injured lumbar spine or pelvis, in which case the trunk portion of the cast usually extends to the armpits. mobility and hygiene mobility is severely restricted by the hip spica cast and walking without crutches or a walker is impossible because the hips cannot bend. there is a serious danger of falling if the patient in a hip spica cast tries to get upright to walk without assistance because they lack the ability to control their balance. patients normally remain in a bed or rely on a reclining wheelchair or children's stroller. children in spica casts can sometimes learn to get mobile by scooting around on skateboards, or pulling themselves across the floor. some children even learn to walk by holding themselves up against furniture. a child in a spica cast must always be supervised and safety must always be considered when they are at a mobile phase of their healing to prevent reinjury or damage to the cast. many spica casts have a spreader bar between the legs to help strengthen the cast and support the legs in the proper positions. it is important when moving the casted patient to not lift them by this spreader bar, as it may break and this could cause injury to the patient. to facilitate toileting or diaper changing and hygienic cleaning, an opening is created in the cast at the groin. the opening is normally referred to as the "perineal opening". it is formed either during cast application or after cast application by cutting the hole with the cast saw. the opening must then be petalled or lined to keep this area of the cast clean and dry. because the hips cannot bend, using a toilet is difficult, if not impossible. it is therefore necessary for the patient to either use a diaper, bedpan, or catheters to manage bodily waste eliminations. bathing must be done by sponge baths. hair may be shampooed by using plastic wash basins under the head. to shampoo wash the hair of a child, the child can be lifted and placed on a kitchen counter top and their head held over the kitchen sink. other casts the minerva cast and the risser cast were formerly used to protect an injured spine or as part of the treatment for a spinal deformity (see scoliosis), but are seldom seen today. the minerva cast includes the trunk of the body (sometimes extending down only so far as the rib cage) as well as the patient's head, with openings provided for the patient's face, ears, and usually the top of the head and hair. the risser cast was similar, extending from the patient's hips to the neck and sometimes including part of the head. both of these casts could, with care and the doctor's permission, be walked in during convalescence. however, in some cases the risser cast would extend into one or more pantaloons, in which case mobility was far more restricted. aside from the above common forms, body casts could come in nearly any size and configuration. for example, from the 1910s to the 1970s, use of a turnbuckle cast, which used metal turnbuckles to twist two halves of the cast so as to forcibly straighten the spine before surgery was common. the turnbuckle cast had no single configuration, and could be as small as a body jacket split in half, or could include the head, one or both legs to the knees or feet, or one arm to the elbow or wrist. despite the large size and extreme immobilization some casts, particularly those used in or before the 1970s, the popular term full body cast is something of a misnomer. the popular and media-driven conception of a massive cast encasing all four limbs, the trunk, and the head – sometimes leaving only small slits for the eyes, nose, and mouth – is a true rarity in recorded medical history, and this type of large scale cast appears more commonly in various hollywood movies and on television shows. the term body cast (or full body cast) is sometimes casually used by laymen to describe any of a number of body or spica casts, from a simple body jacket to a more extensive hip spica. materials fibreglass and polyurethane casting material, 4ply cotton and plaster casting material, (plaster cast) 4ply due to the nature of the dressing, the limb is unreachable during treatment, and the skin under the plaster becomes dry and scaly because the discarded outer skin cells are not washed or brushed off. also, plaster of paris casts can result in cutaneous complications including macerations, ulcerations, infections, rashes, itching, burns, and allergic contact dermatitis, which may also be due to the presence of formaldehyde within the plaster bandages. in hot weather, staphylococcal infection of the hair follicles and sweat glands can lead to severe and painful dermatitis. other limitations of plaster casts include their weight, which can be quite considerable, thus restricting movement, especially of a child. removal of the cast requires destroying the cast itself. the process is often noisy, making use of a special oscillating saw that can easily cut the