INSTRUCTIONS FOR CARE OF PLASTER CASTS

1) Keep patient on strict bed rest for 24 hours with the affected extremity elevated above heart level to decrease swelling (or in a sling as per my instructions).

2) Do not stand or walk on casts unless they are "walker" casts. Do not stand on walking casts for 36-48 hours after application.

3) Place an ice bag over the fractured area for the first 48 hours if possible. Take care not to get the cast wet. DO NOT apply heat. You may help keep the cast dry with a fan.

4) Encourage the patient to frequently move fingers or toes of the affected extremity as soon as possible. Fingers should be opened and closed or toes should be wiggled 20 times every hour while awake.

5) If the fingers or toes become badly swollen, pale, blue, cold, or numb, or if the patient is unable to move his fingers or toes, please call my office or take him to the emergency room immediately.

6) If the pain in the injured extremity becomes MORE severe following application of the cast and is not relieved by pain medication in an hour, or if the cast becomes PAINFULLY tight, call my office or take patient to the emergency room immediately.

7) Keep the cast dry. DO NOT remove or alter the cast. The cast may be signed but not painted.

8) If you are unwilling to "sponge bathe" you may attempt to shower or bathe with the cast sealed in a plastic bag. Dry off under a fan afterwards to prevent perspiration from wetting the cast.

9) If the cast becomes soft or broken, call for return for repairs. If the cast becomes very loose or produces a pressure sore, return for a check.

10) Do NOT put any object inside the cast and do NOT scratch inside the cast with anything since sores may develop.

11) If any SERIOUS question as to care of the patient arises, phone your Physician's office.

12) Make an appointment promptly and please keep your appointment.

PLEASE READ AND FOLLOW DIRECTIONS CAREFULLY TO AVOID UNNECESSARY APPLICATIONS OR ADDITIONAL CASTS. WE FEEL THAT BY FOLLOWING THESE DIRECTIONS, BOTH THE PATIENT AND THE DOCTOR WILL BENEFIT GREATLY.

FRACTURE CASES: SEVEN WARNINGS

1) The fracture may not heal. Failure to heal is particularly noted in fractures of the tibial shaft (shinbone), forearm in adults, and neck of the hip.

2) The fracture may heal with angulation and mal-location. A certain amount of angulation is acceptable and will straighten out all right with time (years).

3) Fractures that communicate with a joint may give rise to arthritis. This means discomfort with weather changes and partial stiffness. In some people the arthritis is severe and may require a new joint or a surgical stiffening of the joint to alleviate the pain. Healing by displacement and bayonet apposition is common. This leads to some shortening, but with many fractures this is unavoidable and must be accepted.

4) Temporary stiffness of joints is often seen after fracture healing and discontinuation of casting. Usually this is temporary (months). However with fractures of the forearm, elbow, ankle, knee joint, wrist, and about the shoulder, permanent partial stiffness is common.

5) In those fractures that require pinning or plating, the incidence of stiffness is higher.

6) Infections after pinning and plating do occur. In our experience this is an uncommon occurrence. Infections may be permanent and give non-union, pain, stiffness, and periodic drainage.

7) Infections are common where the bone has punctured the skin. Some of these cases go on to severe gas gangrene infections and require losing the limb.

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