Orthopaedic Essentials: Casting for Immobilization
Linda Altizer

Orthopaedic Nursing
April 2004 
Volume 23  Number 2
Pages 136 - 141
  PDF Version Available!


  • Application Methods

  • Types of Casts

  • Cast Care

  • Nursing Care

  • Conclusion



  • Figure 1

  • Figure 2

  • Figure 3

  • Figure 4

  • Figure 5

  • Figure 6

  • Table 1

    Casting has been a method of immobilization for fractures for many years and is still being used successfully. When satisfactory reduction is performed on a fracture site, it is necessary to maintain alignment until primary union has occurred. The various forms of immobilization include casting, continuous traction, or a form of splinting. This article reviews the important issues in cast application and maintenance and ways to avoid possible complications.

    Plaster bandages consist of a roll of muslin stiffened by starch or dextrose, which is impregnated with the hemihydrate of calcium sulfate. As water is added, the calcium sulfate absorbs its water of crystallization. This reaction is exothermic and as several minutes pass, the plaster becomes rock hard. Some substances can be added to the bandage to provide a variety of setting stages from slow to fast. Settings can be slowed by adding salt and may be increased by increasing the temperature of the water or by adding alum.

    Application Methods

    There are a variety of application methods, and each orthopaedist usually has his or her preference. The three major methods are skin-tight cast, bologna cast, or third-way cast.

    A Viennese fracture surgeon, Dr. Bohler, promoted the skin-tight method. It involved applying plaster directly to the skin without the use of any padding or intervening material. This type required a well-skilled person and, after application, had multiple complications, such as pressure sores and circulatory impairment. Because there was no padding, ...

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