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 Material

Commercially available stockinettes and cast padding are utilized for all casts. Use of a stockinette sleeve can help reduce skin burns when the cast is removed (Figure 1A and B). Cast padding is imperative to reduce the risk of skin complications; bony prominences should be padded adequately. Casting material should not be in contact with bare skin because it may cause exfoliative dermatitis.[2] The advantages of plaster are lower cost and superior molding ability. The disadvantages are decreased radiolucency, and increased time needed to dry.[1,3] Fiberglass has been used since the 1970s. It is stronger, lighter, and more radiolucent.[2,4] However, fiberglass is more expensive, has inferior molding ability, and may cause increased risk of skin abrasions.[5–7] Hybrid casts comprised of plaster first followed by another layer of fiberglass are an option that combines advantages of both materials (Table 1).[1,7]

Figure 1.

(A through C) Applying stockinette and cast padding. Thumb padding with scissor technique at the thumb.

Coss et al.[6] reported that 94% of the parents of patients requiring serial casting preferred the synthetic cast to traditional plaster of Paris. There was a similar rate of skin irritation with each type of cast in that study, but the fiberglass cast had significantly higher ratings for durability, convenience, performance, cast breakdown, and ease of removal.[6] Additionally, Marshall et al.[4] confirmed the durability of fiberglass, reporting that thumb spica, short arm, and short leg casts lasted on average twice as long as plaster of Paris casts.