• Reference Number: HEY-506/2021
• Departments: Orthopaedics
• Last Updated: 8 July 2021

Introduction

This leaflet has been produced to give general information for patients and carers of a patient with a lower limb cast.  Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion.   If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

Cast care information

Your cast has been applied to keep your injury from moving so that you feel less pain and to help the healing process.

1. A Plaster of Paris cast takes 24 hours to dry.
2. A synthetic cast takes 1 hour to dry.
3. Casts must be kept dry at all times.
4. Elevation is important to reduce swelling.
5. Leg casts must not be walked on unless you are specifically advised that you can do so. (If you are able to walk with this cast, you will be provided with a shoe which must be worn).
6. Movement of joints and digits (toes, knees and hips) outside of the cast for 5 minutes in every waking hour is extremely important.
7. Do not poke anything down the cast as this may cause a sore, do not add any extra padding as this may make the cast tight.
8. Do not use a sunbed whilst wearing a cast.

If you drive a vehicle with a cast on you, may be liable to prosecution under the Road Traffic Act 1988. Please check with your insurance company that they still provide cover.

Complications that may occur whilst in the cast

If any of the following occur contact the Fracture Clinic medical staff. In an emergency when the clinic is closed, contact the Emergency department.

1. Increased pain that is not helped by pain relief and rest. Any pain in the calf.
2. Swelling, numbness, blueness, paleness or discolouration which is not bruising.
3. Pins and needles.
4. You or  the patient are unable to move your or their toes, ankle, knee or hip if not in cast.
5. You or the patient feel a burning sensation under the cast as this could be a blister or sore.
6. Any discharge or smells which come through the cast.
7. An object gets dropped down the cast.
8. The cast becomes loose or tight.

Treatment to reduce the risk of thrombosis (blood clots) of the lower leg (Patients over 18 years of age)

There are two treatment options to reduce the risk of venous thromboembolism (blood clots) in the deep veins, (mostly in the lower leg or in the lungs called a pulmonary embolism). Patients assessed as requiring this will be given the option of two treatments for blood thinning medicines.

Orthopaedic fracture clinic staff to complete the box below for those patients assessed as requiring treatment:

Subcutaneous Injection – Dalteparin (Fragmin)	YES/NO
Capsule – Dabigatran	YES/NO

If you do develop cramps, calf pain or swelling, breathlessness or chest pain, please contact the hospital urgently.

Care when in a lower limb cast

1. Leg to be elevated on pillows higher than the height of your or the patient’s heart (2-3 pillows required). Pillows to be placed under thigh and calf (not under heel), to prevent pressure on the heel. Heels should not be rested directly onto the bed.
2. When you or the patient is seated in a wheelchair or chair, the leg should still be elevated on a stool with a pillow placed under the calf to protect the heel from pressure.
3. Please check the top and bottom of the cast daily for any redness, undue swelling, blistering or broken skin. Report to the Fracture Clinic immediately if any smells or staining come through the cast.

Removable casts

If the doctor has said you may remove your cast for bathing, you may need someone to help you to do this.

If the doctor has said that the cast is to be removed for physiotherapy or wound checks, then it should not be removed at any other time as this may affect your injury.

To remove a cast with Velcro straps or bandage, undo the strap or the bandage. Spread open the flexible section of the cast using your hand, you may need help to do this and carefully lift the limb free of the cast.  To reapply your cast, reverse this procedure: please be very careful to make sure that your leg returns to the position it was in before you removed the cast.  Make sure the straps or bandages are firmly fastened but are not overly tight.

DO NOT stop wearing your cast until your doctor has said it is safe to do so.

Orthopaedic/fracture clinic staff to complete

Can the cast be removed daily for hygiene and skin check?	Yes / No / Not Applicable
Can the cast be removed for exercises?	Yes / No / Not Applicable
Can the cast be removed to have a bath or shower?	Yes / No / Not Applicable
Was the skin intact prior to cast application?	Yes / No / Not Applicable
Is there a sore, wound or suture present?	Yes / No / Not Applicable
If the answer to the previous question is YES is a district nurse required?	Yes / No / Not Applicable
Has this been arranged?	Yes / No / Not Applicable
Has the patient or carer been advised regarding treatment and care?	Yes / No / Not Applicable

Contact details

If you develop complications or require further advice on the issues contained in this leaflet, please do not hesitate to contact the Fracture Clinic or the Emergency Department on the following numbers.

Fracture Clinic (01482) 674378 / 674380

Children’s Fracture Clinic (01482) 675731

Emergency Department (01482) 482192

If it is a non-emergency and you reach an answerphone, please leave a message and we will get back to you.

The Fracture Clinic staff are available to visit inpatients on a hospital ward to give advice.