Cast Application Techniques for Common Pediatric Injuries

A Review

Karim Sabeh, MD; Amiethab Aiyer, MD; Spencer Summers, MD; William Hennrikus, MD


Curr Orthop Pract. 2020;31(3):277-287. 

In This Article

Cast Complications

Casts and tight bandages including splints can cause compartment syndrome.[8,9,17,19] Although uncommon, compartment syndrome remains the most devastating complication. Red flags of compartment syndrome include pain to passive stretch, pain out of proportion to physical examination, paresthesia, or any sign of vascular compromise such as severe swelling, pallor, delayed capillary refill or dusky appearance of exposed extremities.[20,21] In children, however, the diagnosis of compartment syndrome can be difficult because the common presenting symptoms can be unreliable and may present after irreversible damage has already occurred.[22] Bae et al.[22] suggested that in the pediatric population, the presence of agitation, anxiety, and more conspicuously increasing analgesic requirement are more sensitive markers and may aid in an earlier diagnosis and treatment. If compartment syndrome is suspected, an immediate return visit to the surgeon's office or emergency department is warranted for cast splitting or removal.

In addition, pressure ulcers, skin irritation, bacterial or fungal skin infections, allergic reactions, and joint stiffness can result from immobilization. Complications can be minimized with proper application technique, effective patient education, and timely follow-up.[18,23–25] Lastly, thermal injury can occur from excessively thick plaster, use of dip water over 24 degrees, or resting the cast on a pillow while it is maturing.[11–13]