Durgical
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Cast and splint care: drying, checks, skin, itching and teaching

  • Procedure

A new cast or splint is kept dry and uncovered while it sets, the limb is raised and checked often, and the patient learns the warning signs.

Updated

What it is

A cast or splint holds a fracture still while it heals, but it can also press on the skin, trap heat while it sets, or become too tight as the limb swells. Nursing care covers the hours after application, while the material hardens and swelling peaks, and teaching for home. The nurse supports the cast without denting it, keeps the limb raised, repeats neurovascular checks, looks at the skin at the edges, and reports pain, tightness, heat or a smell under the cast. Most skin problems under casts are linked to wet casts, poor padding and objects pushed inside, so prevention is mostly teaching.

Indications

  • A new plaster or fibreglass cast, or a splint, after a fracture or reduction.
  • Immobilisation after surgery or soft-tissue injury.
  • The first hours after application, while the cast sets and swelling increases.
  • Teaching the patient and family before going home.

Contraindications and precautions

  • Do not press on a setting cast or change the joint angle while it cures: dents and angle changes cause pressure sores underneath.
  • Do not rest a setting plaster cast on a pillow or under blankets: heat cannot escape and the skin can burn.
  • Take off rings and tight jewellery on the injured limb: swelling can trap them.
  • Patients who cannot feel or report pain or numbness, for example after a nerve block or epidural, need closer checks.
  • Do not trim, break or pull out padding; any change to the cast follows the team's order.

Equipment

  • Pillows or a sling to support and raise the limb once the cast has set.
  • Waterproof sleeve or cover for washing, if the protocol allows.
  • Torch to look at the skin at the cast edges.
  • Neurovascular observation chart and the service's pain scale.
  • Written home instructions with warning signs.

Step by step (and why)

  1. Identify the patient and explain the care — understanding helps the patient report problems early.
  2. Support the setting cast evenly and avoid pressing on it or changing the joint angle — dents and angle changes while it cures create pressure points inside.
  3. Leave a setting plaster cast uncovered with air around it — trapped heat can burn the skin.
  4. Raise the limb above heart level on pillows once the cast can be supported, unless compartment syndrome is suspected — elevation limits swelling.
  5. Check colour, warmth, capillary refill, sensation, movement and pain beyond the cast at the protocol intervals — a cast can become too tight as swelling rises.
  6. Look at and feel the skin at the edges, and ask about burning or a localised sore spot — these can signal a pressure sore under the cast.
  7. Ask about pain at each check and give the ordered pain relief — pain that does not settle must be investigated, not just treated.
  8. Teach: keep the cast dry, cover it to wash, dry a wet cast with a cool hair dryer and call the team — wet padding damages the skin.
  9. Teach: no scratching or objects inside, no powder or lotion under the cast, no weight on it unless allowed — these cause skin injury or break the cast.
  10. Record the cast type, the checks and the teaching given — the record shows trends and supports continuity of care.

Complications

  • Compartment syndrome or loss of blood flow from a tight cast.
  • Pressure sores under the cast or at its edges.
  • Skin burns from a setting plaster cast.
  • Skin maceration or infection from a wet or soiled cast.
  • A blood clot in the leg that can travel to the lungs (chest pain, shortness of breath, coughing blood).

Next step: when to call for help

  • Report at once pain that does not ease with pain relief and elevation, numbness, pins and needles, or trouble moving the fingers or toes.
  • Report at once fingers or toes that are pale, blue, white or cold, or a cast that feels too tight.
  • Report burning, heat, a foul smell, new drainage or staining on the cast, fever, or a cracked or softened cast.
  • Call urgently for chest pain, shortness of breath or a sudden cough with blood.
  • Before discharge, check that the patient can repeat the warning signs and knows where to go.

Test yourself

Think of the answer, then tap the question to see it.

Why should a setting cast not be pressed or the joint moved while it cures?

Dents and changes in the joint angle while the cast cures create pressure points that can cause sores under the cast.

Why should a setting plaster cast not rest on a pillow or be covered?

Plaster gives off heat as it sets; if the heat cannot escape the skin can burn.

What should the patient do if the cast gets wet?

Dry it with a hair dryer on the cool setting and contact the team that applied it.

What should the patient avoid doing about itching under the cast?

Scratching or pushing anything inside, and putting powder or lotion under the cast; these can injure the skin.

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Connections

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Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: Closed reduction of a fractured bone - aftercare, MedlinePlus Medical Encyclopedia (MedlinePlus, US National Library of Medicine, 2026); McGraw-Heinrich JA, Wall JC, Rosenfeld SB. Common cast complications. J Pediatr Soc North Am 12:100244 (Journal of the Pediatric Orthopaedic Society of North America (PubMed Central, open access), 2025); Compartment syndrome, MedlinePlus Medical Encyclopedia (MedlinePlus, US National Library of Medicine, 2026).

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Representative model, for educational purposes only.