The forearm bones (radius and ulna) are the two most commonly broken bones in the body. 1 Immediate management of these injuries includes applying a plaster cast—called a back slab—to the dorsal aspect of the forearm. These casts are a simple and effective way of providing temporary stabilisation of the fracture and pain relief. All medical students and junior doctors should know how to apply a dorsal back slab. 2 It is usually applied in the emergency department or orthopaedic theatre, but it might also be required during expeditions or in remote settings on elective placement.
The back slab bridges the gap in treatment until definite fracture fixation takes place—that is, an operation is planned within a few days or a full circumferential cast is applied once swelling has settled. In both cases, a fracture of a forearm bone will take about six weeks to heal.
It is important that a back slab does not encircle the limb to allow for some expansion secondary to swelling, and it should be easy to remove. A back slab can be applied with or without manipulation of the fracture, and it can play an important part in managing a fracture conservatively.
However, application of the back slab is not without its risks. Circulatory or nerve impairment can occur if a back slab is applied too tightly, and pressure ulcers can develop if padding at bony prominences is not applied appropriately. 2 3 Practice is all that is required to become proficient in applying a cast, and the fracture clinic or emergency department plaster room can be a source of training and support. The principles learnt from casting the forearm can be applied to other parts of the body. The British Orthopaedic Association’s patient liaison group states that they expect that anyone who requires …
Plaster casts are made up of a bandage and a hard covering, usually plaster of paris. They allow broken bones in the arm or leg to heal by holding them in place, and usually need to stay on for between 4 and 12 weeks.
Taking good care of your cast will help ensure a better recovery.
Plaster cast care advice
Keep your arm or leg raised on a soft surface, such as a pillow, for as long as possible in the first few days. This will help any swelling to go down.
Do not get your plaster cast wet. This will weaken it, and your bone will no longer be properly supported.
It’s possible to buy special covers for plaster casts to keep them dry when washing or bathing. Ask a pharmacist for more information. Do not try to use plastic bags, bin liners, cling film or similar to keep the cast dry, as these are not reliable methods.
If your cast gets wet, contact your hospital or minor injuries unit for advice as soon as possible.
Always remove any covering as soon as you can to avoid causing sweating, which could also damage the cast.
Even if the plaster cast makes your skin feel very itchy, do not poke anything underneath it. This could cause a nasty sore and lead to infection.
Do not walk on a cast unless you have been told it is safe to do so and have been given a plaster shoe.
The itchiness should settle down after a few days.
More plaster cast tips:
- exercise any joints that are not covered by the cast – such as your elbow, knee, fingers or toes – to help improve your circulation
- avoid getting small objects, powders and sprays inside your cast, as they could irritate your skin
- do not try to alter the length or position of your cast
- do not lift anything heavy or drive until the cast has been removed
- use crutches or a sling as advised by your health professional
- use painkillers if you experience any pain
- you can usually return to school or work with a cast, but you should avoid strenuous activities that may damage the broken bone or cast
Plaster cast problems
You should contact your local hospital or minor injuries unit for advice if:
Get medical advice as soon as possible if you think you have broken your arm or wrist. Any possible breaks need to be treated as soon as possible. It’s not always clear if your arm or wrist is broken or just sprained so it’s important to get your injury looked at by a healthcare professional.
Urgent advice: Get advice from 111 now if:
You have had an injury to your arm or wrist and:
- the injury is very painful
- there is a large amount of swelling or bruising
- you cannot use the affected arm or wrist due to the pain
111 will tell you what to do. They can tell you the right place to get help if you need to see someone.
Other ways to get help
Go to an urgent treatment centre
Urgent treatment centres are places you can go if you need to see someone now.
They’re also called walk-in centres or minor injuries units.
You may be seen quicker than you would at A&E.
Immediate action required: Go to A&E or call 999 if:
- the affected arm or wrist is numb, is tingling or has pins and needles
- you have a bad cut that is bleeding heavily
- a bone is sticking out of your skin
- your arm or wrist has changed shape or is at an odd angle
Things to do while you’re waiting to see a doctor
gently hold an ice pack (or a bag of frozen peas wrapped in a tea towel) to the injured area for up to 20 minutes every 2 to 3 hours
stop any bleeding by applying pressure to the wound with a clean pad or dressing if possible
remove any jewellery such as rings or watches – your fingers, wrist or hand could swell up
take paracetamol for the pain
do not eat or drink anything in case you need surgery to fix the bone when you get to hospital
do not try to use the affected arm or wrist
Treatment for a broken arm or wrist
When you get to hospital the affected arm will be placed in a splint to support it and stop any broken bones from moving out of position.
You will also be given painkilling medicines for the pain.
An X-ray is then used to see if there is a break and how bad that break is.
A plaster cast can be used to keep your arm in place until it heals – sometimes this may be done a few days later, to allow any swelling to go down first. You may be given a sling to support your arm.
A doctor may try to fit the broken bones back into place with their hands before applying a splint or cast – you will be given medicine before this happens so you will not feel any pain. If you had a very bad break surgery may be carried out to fix broken bones back into place.
Before leaving hospital, you’ll be given painkillers to take home and advice on how to look after your cast.
You’ll be asked to attend follow-up appointments to check how your arm or wrist is healing.
How long does it take to recover from a broken arm or wrist?
In most cases it takes around 6 to 8 weeks to recover from a broken arm or wrist. It can take longer if your arm or wrist was severely damaged.
You will need to wear your plaster cast until the broken bone heals. The skin under the cast may be itchy for a few days but this should pass.
The hospital will give you an advice sheet on exercises you should do every day to help speed up your recovery.
Your arm or wrist may be stiff and weak after the cast is removed. A physiotherapist can help with these problems, although sometimes they can last several months or more.
Things you can do to help during recovery
try to keep your hand raised above your elbow whenever possible; use a pillow at night to do this
follow any exercise advice you have been given
use the painkillers you have been given to ease pain
do not get your cast wet – waterproof cast covers are available from pharmacies
do not use anything to scratch under the cast as this could lead to an infection
do not drive or try to lift heavy items until you have been told it is safe to do so
Urgent advice: Get advice from 111 now if:
- the pain in your arm or wrist gets worse
- your temperature is very high or you feel hot and shivery
- your cast breaks, or the cast feels too tight or too loose
- your fingers, wrist and arm start to feel numb
- your fingers, wrist and arm look swollen or turn blue or white
- there’s a bad smell or discharge of liquid from under your cast
111 will tell you what to do. They can tell you the right place to get help if you need to see someone.
Other ways to get help
Go to an urgent treatment centre
Urgent treatment centres are places you can go if you need to see someone now.
The humerus — also known as the upper arm bone — is a long bone that runs from the shoulder and scapula (shoulder blade) to the elbow. Fractures of the humerus are classified in one of two ways: proximal humerus fracture or humerus shaft fracture.
A proximal humerus fracture usually occurs close to the shoulder joint and can be located at different levels with different fracture patterns: simple or comminuted. A humerus shaft fracture, on the other hand, is one that is localized at the mid portion of the upper arm.
What causes a humerus fracture?
A broken arm is a common injury and is usually a consequence of a fall with an outstretched hand, a car crash or some other type of accident.
What are the symptoms of a humerus fracture?
Symptoms vary depending on the specific type of fracture but may include:
Swelling and bruising
Inability to move the shoulder
A grinding sensation when the shoulder is moved
Deformity — “It does not look right.”
Occasionally bleeding (open fracture)
Loss of normal use of the arm if a nerve injury occurs
What is the treatment for a humerus fracture?
Proximal Humeral Fracture
Most fractures of the proximal humerus can be treated without surgery if the bone fragments are not shifted out of position (displaced). If the fragments are shifted out of position, surgery is often performed to allow earlier mobility. However, other factors are also considered when deciding between surgical fixation or nonoperative treatment.
Nonoperative treatment is usually with a sling or shoulder immobilizer with no shoulder mobility for the first two weeks. Thereafter, the patient will be given weekly exercises to slowly increase the shoulder’s range of motion. An X-ray of the shoulder will be taken on a weekly or biweekly (every two weeks) basis to confirm the fracture is healing properly.
Surgery usually involves fixation of the fracture fragments with plates, screws or pins. Severe fractures with previous arthroscopy (joint degeneration) may require shoulder replacement. Mobilization with physical therapy is begun immediately following surgery.
Humerus Shaft Fracture
A humerus shaft fracture may be treated with or without surgery, depending on the fracture pattern and associated injuries (i.e., nerve injury or open fracture). A temporary splint extending from the shoulder to the forearm and holding the elbow bent at 90 degrees can be used for initial management of the fracture.
Nonoperative treatment usually includes the placement of fracture bracing that will be replaced by a cylindrical brace (Sarmiento brace) three to four weeks later that fits the upper arm while leaving the elbow free. The doctor will tell you how long to wear the cast or splint and will remove it at the right time. It may take several weeks to several months for the broken arm to heal completely.
Rehabilitation involves gradually increasing activities to restore muscle strength, joint motion and flexibility. The patient’s cooperation is essential to the rehabilitation process. The patient must complete range of motion, strengthening and other exercises prescribed by the doctor on a daily basis. Rehabilitation will continue until the muscles, ligaments and other soft tissues perform normally.
Surgery usually involves internal fixation of the fragments with plates, screws or a nail. The rehabilitation differs slightly from nonoperative treatment, with no splints or cast. The patient is usually given a sling for comfort and arm support. Elbow exercises may be started immediately after surgery, while shoulder exercises may be delayed for a few weeks based on the fracture pattern.
Arm casts are made of a tough fibreglass material that protects your arm as it heals from surgery or injury. There is a soft layer of padding between the arm and cast that protects the arm from lacerations and irritation. There are additional measures you can take to soften your arm cast and make it more comfortable as you heal.
Ask for an extra layer of cast padding. When your cast is applied ask the doctor, nurse or technician who is applying your cast if they can place an additional layer of cast padding underneath the fibreglass. This will allow for more comfort while you are wearing your cast.
Use a sling. A cast can be uncomfortable if the fibreglass rubs up against another part of your body. Placing your affected arm in a sling can provide a buffer between the rest of your body and the cast.
- Arm casts are made of a tough fibreglass material that protects your arm as it heals from surgery or injury.
- A cast can be uncomfortable if the fibreglass rubs up against another part of your body.
Cut up old socks. Take a pair of old athletic socks and cut the foot and toe portion off so that you just have a tube. Place these over your cast for additional comfort and softness.
Never place anything down your cast in order to make it softer. This can irritate your skin and the object is also likely to become stuck in the cast. Avoid wetting your cast. Fibreglass will become softer, but is not waterproof. A wet cast can cause your skin to break down and you will need to have a new cast placed on your arm.
I must say, navigating life without my dominant arm has been an adventure! They say that mastering your non-dominant hand benefits your brain. It’s fun when I notice my left hand and arm getting stronger (carrying a stack of plates from the dining table), more flexible (I can now scrub, shave and deodorize my left pit, yeah baby!), and more skilled (change the sheets on Em’s bed and empty the dishwasher without breaking anything). And I’m learning ways to accomplish everyday tasks we take for granted.
Doing my face and making my hair not look like a rat’s nest is nice when a neighbor stops by unexpectedly to check on me, but it also does a lot of good for my morale and outlook on the day. Learning how to work with my non-dominant hand is like learning from scratch. I thought my tips may help to those who are beauty novices as well as those who may be learning how to work with a non-dominant hand.
Once I got off the painkillers and felt good enough to leave the house for a bit, I made a hair appointment. I asked for lowlights instead of a single process to add depth to my wavy hair and cover gray without visible roots. I told her how I can spray product on my head, but lotions, creams, and hair dryers aren’t happening for a long while. She cut it to let the bangs grow out gracefully and cut long layers that would wave and curl in a beachy way when washed and air dried.
I ordered one of those waterproof cast covers that looks like a giant blue condom, but the largest size was so tight on my upper arm that it worked like a tourniquet making my fingers tingle in just a minute. So I am resigned to baths with my well-wrapped arm sticking out of the tub. I squeeze shampoo directly onto my scalp and scrub it in, and then I slide down to rinse out as much as possible, Karl making sure I don’t slip or miss washing out any product. Conditioner, I squeeze onto the edge of the tub, then scoop it into my hair so I can bypass the scalp and focus on the ends.
When I get out, I put a towel on the bed and bend my head onto it and blot dry. To keep my hair more on the ringlet size and less on the Kip Winger side, I invested in a DevaCurl towel. It’s small enough to use one-handed; I scrunch blot, apply product, then sometimes scrunch blot again if any spot is too drenched. The biggest issue is my bangs; they sometimes curl nicely into my hair, but more often than not they part in the middle and curl up like horns. So I sometimes have Karl point the hairdryer at my roots and I brush my bangs back and forth in a window washer style with a paddle brush (thanks Ted Gibson for the bangs tip!), or use a curling iron and carefully curl them into my hair (random grabs actually work for the bangs, looks more natural).
As for styling products, I have a shelf of spray-bottle products now. Liking Nick Chavez Amazon Infinity Mist for waves, TIGI Bed Head Foxy Curls for ringlets , and once dry, TIGI Bed Head spray shine. For second day, I’ll use Batiste dry shampoo in deep brown which gives body, reduces shine, blends without a ton of rubbing, and provides some control to keep bangs merged with the rest of my hair.
I’ve put my tube of Miracle Skin Transformer in my medicine cabinet so it’s easy to have a minimum of nice skin each day. It has replaced my traditional moisturizer, going over treatment and serum. I know it may be contaminating the tube, but I squeeze the product directly on my face then blend with my fingers.
If I know I am going somewhere or wake energized, I put on actual foundation and concealer. My foundation (Revlon ColorStay Whipped) is in a jar, so it’s easier to apply. When I started, I would dip my Beauty Blender right in the jar and blend onto the skin. Now I feel confident applying with fingers then using the Beauty Blender to blend around the nose and jawline. Concealer goes over the foundation, using Laura Mercier Secret Camouflage, which is dry enough to not be a smeary mess. I pat it into places with my finger, then go back and blend so it has time to dry a bit. This helps because I don’t have as light or precise of a touch and letting it dry a bit keeps me from rubbing it all off.
Next is brows; I’ve found the easiest and most natural is tarte Amazonian Clay Brow Mousse which is sort of a cream, sort of a wax and comes with its own brush. Not nearly as precise as I like but at least my brows are filled in. Better to be too gentle than too hard of a hand; if need be I can go back and tap the brush where there’s pale spots.
Blush is my best friend these days, it really makes me look finished and healthy. I’ve returned to an old favorite, NARS Orgasm, which gives me a healthy glow and doesn’t make me look like a clown if I am too heavy handed. With less other makeup the shimmer in this blush looks more glowy than disco. I switched to my bareMinerals Flawless Application Face Brush, which is fluffier with longer bristles than my blush brush. A traditional blush or powder brush made obvious streaks if I had too heavy of a hand; this brush gives more of a wash of color.
For eyes, I was curling my lashes until I had quite the mishap. Now I’m just using CoverGirl Clump Crusher Mascara which has a tube that can stand up on its own and doesn’t bend when I open it with my teeth (hello metal capped mascara). The formula is water resistant and a bit dry, so I don’t end up with raccoon eyes from shaky application or tears. I sometimes apply shadow, but just one of the nudes from my Urban Decay Naked Basics 1 palette, also applied with a fluffy brush so there’s no strong lines. As I have gotten more skilled with my left hand, I sometimes add a brown shadow in the crease for dimension. I’ve always felt confident with liquid liner, and when I’m feeling really good I’ll do a thin line with Maybelline Line Stiletto right along the lash line, from middle of lid to outer corner; otherwise I put a dampened slant brush in black or black-brown shadow and tap along the lash line which hides the missing lashes.
As for lips, my daily go-to is Revlon Balm Stain; my two faves are Romantic and Adore. When I go out I sometimes wear Revlon Matte lipstick in Really Red which stays nicely, is elegant, and with my glasses makes me look finished.
The arm consists of 3 major bones. The humerus runs from the shoulder to the elbow. This is called the upper arm, or, simply, the arm. At the elbow, the humerus connects with 2 bones: the radius and the ulna. These bones go from the elbow to the wrist and are regarded as the forearm. The bones within the human body are strong, but they can be broken.
How to Break Your Arm
Warning: The steps within this article are for precautionary purposes, breaking a bone is a painful experience and not one you should purposefully impose upon yourself.
1. Walking Down the Stairs with Your Eyes Closed
Walking down stairs with your eyes closed can cause you high amounts of physical damage. The fact that your eyes are closed will diminish your equilibrium and most likely cause you to stumble. This can cause you to damage or break other bones, including your spine and/or cranium, causing serious injury or possibly death.
2. Using Your Legs
Placing your arm in-between your legs (one leg below the arm and the other above) and applying as much force as you can to push the bottom leg upwards, and the other leg downwards upon the sandwiched arm, it will most likely cause the arm to break. One can choose to take a painkiller to help assuage the pain, although it would be wiser to avoid doing this all together.
3. Using Heavy Objects
Knowing ways of breaking arm serves to enlighten on what not to do. If one was to stand beside the corner of a wall and place their arm out next to it (so around half of the arm is touching the wall), then drop a heavy object onto the arm, this would likely cause the bones within the arm to break.
4. Smashing Your Arm Against a Wall
The corner of a wall or table can cause a lot of damage if a body part is repeatedly smashed against it. This may be because it is usually very solid and pointy, meaning there is no possibility of distributing the force of impact. If one was to smash his or her arm against the side of a solid table of wall, then eventually one would hear a crack, snap, or similar noise, indicating that the arm has been broken. Using protective clothing or wrapping the arm with some form of padding may help to ease the pain associated with doing this, but not as much as not doing it would.
5. Climbing Up (and Falling Down) a Ladder
Ladders are very useful tools but they can be dangerous if not used correctly. Before climbing a ladder, ensure that it is stable and level on the ground. Always ensure that the ladder is ascending straight against the surface you wish to scale, if it seems to be swaying or leaning one way or another, do not climb the ladder. Clearly, you’ve learnt how to break your arm, or other bones in your body by doing the exact opposite.
6. Falling in the Shower
Falling in the shower can be easy due to the fact that most surfaces become slippery when wet. On top of taking care whilst showering, it may also be wise to place a shower mat on the floor in your shower, which is designed to offer grip to your feet in such situations. Grab bars are also useful to install within the sower, especially if you are living with someone who is elderly or disabled, this gives those who need it something to grab onto to stabilize themselves. By doing the opposite, which means take away of the shower mat and do not grab the bars, you may break your arm as you wished to.
What Does It Feel Like to Break Your Arms?
Here are some experiences sharing from arm breaking people:
“I’ve had this pain in my arm for a few days and it’s only getting worse. I am not able to think of a certain incident (such as injury or during exercise), where I might have broken it. At first the pain came and went but it has now become constant. I first thought that I may have damaged my rotary cuff, but the pain has become much deeper in my bicep and I can feel it in my bones. I’ve tried to exercise past the injury but my bicep is causing me too much trouble, not sure if it is broken though I am going to pay a visit to the doctor”. – By Amateur Bee Keeper
“When I was eleven I suffered a broken elbow, I remember the pain being so intense I screamed, and my arm swelling profusely and turning purple”. – By Nobody puts Baby in a corner
“A while ago I broke both arms and one wrist in the same incident. The excruciating pain I felt in my arms meant that I didn’t even realize that my wrist had broken. I’ve also broke my nose once which was like stubbing it but much, much worse. When I broke my arms and wrists, it took many hours before I received medical treatment (spending numerous hours in the waiting room, in agonizing pain)”. – By eberg15101
How Are Broken Arms Treated?
For those of you who have found out how to break your arm the hard way, then you will most likely be seeking treatment. Treatment methods depend on the severity and variety of the break or fracture. What should be noted is that there is no quick fix for a broken bone, treatment methods are only intended to reduce discomfort and speed up and aid the natural healing process. The following treatment methods are what one would typically expect:
Rod Brouhard is an emergency medical technician paramedic (EMT-P), journalist, educator, and advocate for emergency medical service providers and patients.
Michael Menna, DO, is board-certified in emergency medicine. He is an attending emergency medicine physician at White Plains Hospital in White Plains, New York and also works at an urgent care center and a telemedicine company that provides care to patients across the country.
To immobilize a broken arm, make sure to immobilize the fracture site as well as the joints above and below the fracture.
Cardboard splints work very well for splinting broken arms in the field.
Items You'll Need
To adequately splint a broken arm, you will need a cardboard splint, towels for padding, bandage scissors, roller gauze, and tape. Other items can be used to immobilize the broken arm. Anything that secures the broken arm and immobilizes it will work.
Assess the Break
Determine the location of the broken bone and assess the arm to make sure victim can still move fingers, feel touch, and has circulation to his or her hand.
Assess the broken arm by feeling the area of the broken bone. Deformity, crepitus (a grinding feeling under the skin), or discoloration may be present in the area of the fracture. In most cases, the victim will just feel pain and tenderness near the injury.
Assess the victim's circulation, sensation, and motion in the hand.
- Ask the victim to identify which finger is being touched.
- Ask the victim to move fingers.
- Feel the victim's fingers to see if they are as warm as the hand on the unbroken arm.
Cut the Splint to the Correct Size
If the cardboard is too long, cut it to size. In this case, cuts are made to help shape the splint.
Shape the Splint to the Arm
Shape the splint to fit the broken arm by folding the splint to wrap around the arm.
Bend the Splint to Fit Around the Elbow
After the splint is cut, bend the splint up to fit around the elbow.
Fold the Remaining Flaps to Finish
Finish the splint by folding the remaining flaps around and tape them in place.
Pad the Splint
Pad the splint with towels or other padding before placing it on the broken arm.
Position the Arm in the Splint
Correctly position the broken arm into the padded splint. Make sure fit is snug, but not tight.
Maintain Position of Function
Put something in the victim's hand (like a roll of gauze) to maintain the position of function. The position of function is achieved when the fingers are slightly curled.
Fill the Voids
Fill all voids (spaces) between the broken arm and the splint with additional padding. The rule: avoid the voids.
Secure the Splint Around the Arm
Secure the splint around the broken arm with tape or roller gauze.
Wrap the splint snugly around the broken arm. The splint should support the broken arm on all sides and immobilize the arm above and below the broken bone. In this example, the broken arm is immobilized from the elbow to the wrist.
Check Arm for Movement
Once the splint is attached, the broken arm should be securely immobilized and should not be able to move.
After the broken arm is secured in the splint, reassess the hand to determine if function and circulation are still intact. Recheck circulation, sensation, and motion.
Reduce Swelling With Ice
Place ice or a cold pack on the injury to reduce swelling. For chemical cold packs, follow the manufacturer's directions. Never place ice directly on skin.
This article was medically reviewed by Luba Lee, FNP-BC, MS. Luba Lee, FNP-BC is a board certified Family Nurse Practitioner (FNP) and educator in Tennessee with over a decade of clinical experience. Luba has certifications in Pediatric Advanced Life Support (PALS), Emergency Medicine, Advanced Cardiac Life Support (ACLS), Team Building, and Critical Care Nursing. She received her Master of Science in Nursing (MSN) from the University of Tennessee in 2006.
There are 11 references cited in this article, which can be found at the bottom of the page.
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An arm sling immobilizes and protects an injured arm. Though broken arms are a common reason for wearing a sling, you do not necessarily have to have a broken bone to wear one – contusions, sprains, and dislocations can also require a sling. Or, potentially a suspected serious injury in an emergency. Regardless of the exact nature of your arm injury, a sling can be vital to your healing process because, in addition to supporting your arm as it heals, it provides a sign to others to treat your arm gently. Knowing how to make an improvised sling is a useful first aid skill; it can make the victim better protected and comfortable until he or she can get to professional medical help.
An orthopedic cast on a patient’s arm, despite limiting his lifestyle, will help a broken bone heal much faster than without one. Modern casts are made out of fiberglass, which is very stiff and keeps the patient’s arm immovable and thus more able to heal. Fiberglass casts can have a waterproof liner placed just under the outside fiberglass layer 1. Once the injury heals and the cast is no longer necessary, it can be removed easily by a doctor or at home. The doctor will use a small, electrical medical saw to cut off the cast. Saws will easily cut through all cast types (including the waterproof layer in fiberglass casts) but will only tickle the person’s arm 1. At home, soaking a cast in a solution of water and vinegar will slowly dissolve the cast.
If you are experiencing serious medical symptoms, seek emergency treatment immediately.
If the cast you are removing is made of plaster, place goggles and breathing mask on yourself and the patient. During sawing, dust can get in your eyes and mouth. Many saws, however, have built-in vacuums, which lessen this hazard.
Most Common Side Effects After Hip Replacement Surgery
Start sawing at the top of the arm (the shoulder or elbow) in the direction of the hands.
Saw one side along the arm until cut, and then saw the opposite side.
How to Remove a Cast
Saw with an up and down motion to keep the saw from getting jammed or stuck. Grasp the saw handle close to the saw blade for maximum control.
Remove the cast with a cast spreader. It will come off easily because the cast is in two pieces due to cutting it on opposite sides.
Cut away the padding, or stockinet, with scissors. Start at the top of the arm towards the hand.
Use rubbing alcohol on a piece of cotton wool to clean the arm. It will wash away dead skin and dirt build-up. Dispose of the cast immediately.
- If the cast you are removing is made of plaster, place goggles and breathing mask on yourself and the patient.
- Saw with an up and down motion to keep the saw from getting jammed or stuck.
Find a bucket large enough for your whole cast to fit in. Fill it with warm water and 1 tbl. of vinegar.
Soak the cast-clad arm for one to two hours until the wrapping starts to loosen. Unwrap the cast until it is completely removed. Dispose of the cast.
Dispose of the water outside, rather than pouring it down your sink; the plaster can clog your pipes.
Casts and splints are hard wraps used to support and protect injured bones, ligaments, tendons, and other tissues. They help broken bones heal by keeping the broken ends together and as straight as possible. Casts and splints also help with pain and swelling and protect the injured area from more harm.
What is the difference between a cast and a splint?
A cast wraps all the way around an injury and can only be removed in the doctor’s office. All casts are custom-made with fiberglass or plaster.
A splint is like a “half cast.” The hard part of a splint does not wrap all the way around the injured area. It is held in place by an elastic bandage or other material. Unlike casts, splints can be easily removed or adjusted. Many splints are custom-made from fiberglass or plaster. Others are premade (“off-the-shelf”) and come in lots of shapes and sizes for different injuries.
What are they made of?
The inside layer may be a “sock-like” material called a stockinette and is used more often with casts than with splints. Padding is also used to protect the skin and tissues under it and to make casts and splints more comfortable. Padding can be made from cotton or a man-made material.
The outer layer is usually plaster or fiberglass. Your doctor will pick the best materials for you. Fiberglass and plaster are put on while they are wet. Fiberglass dries in 15 to 30 minutes, but plaster can take longer.
If you are walking on the cast or splint, the drying time will be longer. On average, plaster will take about a day and a half before it’s hard enough to support your weight, but fiberglass will take about 20 to 30 minutes.
How long does a cast or splint stay on?
A splint usually stays on for several days to weeks. If the injured area is very swollen, a splint may be used first to allow for that swelling. If you need a cast, your doctor will remove the splint and apply a cast. Casts that are kept in good condition can stay on for several weeks. Your doctor will tell you how long your cast will need to stay on.
Splints and casts often need to be adjusted in the first few days if your injury is swollen. As the swelling goes down, a cast may become too loose. If swelling increases, the splint or cast may become too tight.
What if the pain gets worse?
Keep the injured area above the level of your heart (for instance, prop it up with pillows).
Wiggle your fingers or toes while resting.
Apply ice, if needed. It can be used for 15 to 30 minutes over a cast or splint as long as the ice doesn’t get the splint or cast wet or touch the skin for too long.
Talk to your doctor before taking pain medicine.
When should I call my doctor?
Numbness, tingling, burning, or stinging on or near the injured area
Circulation problems (if your skin, nails, fingers, or toes become discolored, pale, blue, gray, or cold to the touch, or if you have trouble moving your fingers or toes)
Bleeding, pus, drainage, or bad smells coming from the cast
A wet, broken, or damaged cast or splint
Your doctor may need to adjust, remove, or change your splint or cast. Call your doctor right away if you have any of these symptoms.
What should I do when I bathe?
Be sure to keep your cast or splint dry, especially during baths and showers. Casts and splints made from plaster can break if they get wet, and your skin can break down. Fiberglass casts are water-resistant, but the lining will absorb water. So if the lining gets wet, the skin underneath may become irritated or infected.
When you bathe, wrap two layers of plastic over the cast or splint and make sure a plastic bag is tightly sealed over it. This will make it water- resistant , but not water proof , so do not put the cast or splint directly in water. Moisture can damage the outside of the cast or splint, but, more importantly, a wet cast can irritate the skin or cause infection.
What else do I need to know?
Never stick objects inside a cast or splint. They can get stuck, break off, or hurt your skin.
Don’t get dirt or sand inside a cast or splint.
Don’t apply powders or deodorants inside a cast. For severe itching, call your doctor.
Never break off pieces of your cast or splint or try to adjust it yourself. If it needs to be adjusted, call your doctor.
Check the cast and the exposed skin daily. If you notice damage to the cast or any injury, call your doctor.
How is a cast taken off?
Your doctor will use a special cast saw with a blade that vibrates but does not spin. It cuts through the outer layer, but not the lining.
Never remove a cast yourself. Using any type of home saw or cutting materials could cause serious injury to your skin, blood vessels, and injured limb.
Where can I get more information?
American Academy of Family Physicians
American Academy of Orthopaedic Surgeons
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This handout is provided to you by your family doctor and the American Academy of Family Physicians. Other health-related information is available from the AAFP online at http://familydoctor.org.
This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.
This article was co-authored by Jonathan Frank, MD. Dr. Jonathan Frank is an Orthopedic Surgeon based in Beverly Hills, California, specializing in sports medicine and joint preservation. Dr. Frank’s practice focuses on minimally invasive, arthroscopic surgery of the knee, shoulder, hip, and elbow. Dr. Frank holds an MD from the University of California, Los Angeles School of Medicine. He completed an orthopedic residency at Rush University Medical Center in Chicago and a fellowship in Orthopedic Sports Medicine and Hip Preservation at the Steadman Clinic in Vail, Colorado. He is a staff team physician for the US Ski and Snowboard Team. Dr. Frank is currently a scientific reviewer for top peer-reviewed scientific journals, and his research has been presented at regional, national, and international orthopedic conferences, winning several awards including the prestigious Mark Coventry and William A Grana awards.
There are 9 references cited in this article, which can be found at the bottom of the page.
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A fractured or broken bone is always considered a traumatic injury, but not all are classified as serious — there are different types based on severity. A hairline or stress fracture of bone is the least traumatic and doesn’t result in misaligned pieces. Fractures that result in pieces that are misaligned, particularly if they poke through the skin, are much more serious and sometimes life threatening. Consequently, realigning a broken bone in a timely manner is crucial, but not a procedure that should be attempted by someone untrained. Fracture realignment should be performed by a surgeon or physician ideally, although other health professionals and first responders may have to suffice in some emergency situations.
An arm cast doesn’t have to be the eyesore it used to be. Gone are the days of the plain, white plaster and smeared pencil autographs. Orthopedic companies offer plenty of creative options for the cast wearer and advances in permanent markers means expressing yourself in clear, crisp lines. The new decoration options make it almost cool to be cast.
Paint an intricate design or scene on your cast with acrylic paints and small brushes. If the location of the arm cast makes painting it yourself difficult, ask a friend to draw up a design and paint it on your cast. Seal the design with a clear paint sealant and protect it while showering by placing the cast in a plastic bag.
Use a shrink-wrap product designed specifically for leg and arm casts. Commercial products like “Casttoo” and “Shrinkins” use the heat of a hair dryer to custom wrap your cast with a decorative design such as flowers, animals, sports items and even bone images. Easy to do with beautiful results, your cast will have people talking.
Ask your friends to sign their autographs in creative ways. Use colored, permanent markers and ask your friends not to only sign their names, but to write their names in unusual fonts and in various sizes to decorate your cast. Use both wide and narrow markers for variety.
Request a colored “top coat” on your cast to create a bright canvas. When the cast is applied, you’ll most likely be offered a a choice of colored casting material. Use a bright color as your backdrop and have friends doodle on your cast with black permanent markers.
Have a decorating party. Invite three or four of your most artistic friends and ask them to collaborate on a design for your cast. Use permanent markers and ask them to work together to create an abstract art piece.
Hot glue a few sparkly rhinestones, faux gemstones or silk flower blossoms to add a festive touch to your cast. Applying enhancements means taking extra care in the shower. Also, check with your doctor to see if the accessories will impede the cast removal.
If you like to change your look use a product like Arm Candy, which features an elastic-style cover that fits over your cast without permanently changing it.
Don’t allow friends to write curse words or other inappropriate remarks on your cast.
A cast is a hard bandage that keeps part of the body from moving so it can heal.
Why Do People Need Casts?
People get casts after a broken bone, some surgeries, and other injuries.
What Are the Different Kinds of Casts?
Most casts are made of fiberglass. Fiberglass is a kind of plastic that is moldable and dries hard. Some fiberglass casts are waterproof.
Less often, casts are made of plaster of paris. This white powder is mixed with water into a paste. The paste hardens when it’s dried.
Is There a Waterproof Cast?
Yes, there is a cast that can be worn in showers and pools. A waterproof cast is a regular fiberglass cast with a different type of liner. Doctors use waterproof casts only for some kinds of broken bones.
How Are Casts Put On?
A health care provider such as an , emergency room doctor, , orthopedic technician, or puts on the cast.
To put on the cast, the health care provider:
- wraps a liner of soft material around the injured area (for a waterproof cast, a different liner is used)
- wets the cast material with water
- wraps the cast material around the first layer
- waits until the outer layer dries to a hard, protective covering
A fiberglass cast gets warm as it hardens. It cools in about 15 minutes.
How Can I Prevent Problems With a Cast?
If the cast is not waterproof, keep the cast and liner dry. A wet cast or liner can lead to a skin rash or infection.
- Don’t pull out the lining or break off any parts of the cast.
- If there is a sharp edge, put tape or moleskin on the edge of the cast.
If the cast is itchy:
- Tap on the outside of the cast.
- Use a hair dryer on the cool or fan-only setting to blow air in at the edges of the cast.
- Never use an object to scratch under the cast. Scratching can lead to an infection or sores. Don’t apply lotion or powder inside the cast.
How Should I Care for the Cast?
If the Cast Is Waterproof:
- Flush the cast and liner with clean water to remove soap after showers.
- Dry the waterproof cast with a hair dryer on the cool or fan-only setting after showering or swimming.
If the Cast Is Not Waterproof:
Casts that don’t have a special waterproof liner must be kept dry. It is better to take a bath than a shower because it is easier to keep the cast dry in a bath. To keep the cast dry while bathing:
- Before the bath, cover the cast with two plastic bags. First, put one bag on and seal the top with a rubber band. Then, put the second bag on and seal it with another rubber band.
- Some people use a waterproof plastic cast protector instead of plastic bags. You can buy this at a drugstore.
- Keep the cast completely out of the water by propping it up on the side of the tub.
If the cast or liner gets splashed, gently blow air into it from a hair dryer on the cool or fan-only setting. If some of the cast or liner goes under water or gets very wet, call your doctor.
When Should I Call the Doctor?
Call your doctor if:
- The cast feels too tight.
- The cast was comfortable but is now uncomfortable.
- You have new pain or pain that gets worse.
- Your fingers or toes get more swollen, change colors, hurt, or feel numb.
- Something is stuck in the cast, like a piece of food.
- A bad smell or any kind of fluid is coming from the cast.
- A non-waterproof cast or liner gets wet.
How Are Casts Taken Off?
Health care providers take off casts with a small electrical saw. The saw cuts through the cast material but stops before it touches the skin.
When the cast is off, the skin will probably look pale, dry, or flaky. The hair will look darker and the muscles will look smaller. This is normal and goes away within a few weeks.
Take care of your cast so it stays in good condition and does not lead to irritation. Within a few months, you can get back to all the activities you enjoyed before the injury.
A broken radius is a common fracture of the upper limb. It can occur if you fall or if you’re involved in high-impact sports like football. It’s also common among people with osteoporosis. If you have received treatment for a broken wrist and wear a cast or splint, these seven distal radius fracture recovery exercises will help you cope until your wrist heals completely.
1. Elevate Your Wrist
To reduce swelling and pain, raise your wrist so it’s above your heart. After a doctor places a cast on your wrist, you need to elevate it for the first 48-72 hours. You may need to keep your wrist raised in the daytime and while sleeping.
2. Apply Ice
Placing ice on your wrist can help stop swelling and relieve pain. However, it’s important to keep your cast dry. Here’s a few tips when applying ice to your wrist:
- Wrap an ice pack in a towel to prevent water from touching the cast.
- If you don’t have an ice pack, wrap a bag of frozen vegetables in a towel to use.
- Apply ice to your wrist for up to 20 minutes every three hours.
- Keep applying the ice for at least three days or longer based on your doctor’s recommendation.
3. Use Pain-Relieving Medication
As directed by your doctor, use pain-relieving medication or over-the-counter pain medicines like ibuprofen and naproxen sodium. It’s important to consult your doctor about any pain medication as some can interfere with other medications. You should only take aspirin if you don’t have conditions such as anemia, asthma or a bleeding disorder. The use of over-the-counter medicines can be limited to 10 days or as directed by your physician.
4. Exercise Joints Near the Wrist
You should exercise the joints that aren’t in a cast, including your fingers and elbow. Wiggling your fingers and moving your elbow around will quicken the pace of your healing and help improve mobility. If you observe pain while moving these joints, talk to your doctor.
5. Keep Your Cast Dry
Always do your best to keep your cast dry. Casts are made of plaster, which water can damage. Keeping your cast dry will also prevent the growth of mold or mildew in the cast. You can keep your cast dry by:
- Taping a thick plastic bag over the cast while you shower or bathe
- Wrapping a towel around the upper part of your cast to stop water from getting into it
- Using a cast-shield with adequate water resistance
6. Work With a Physical Therapist
After your cast is removed, physical therapy will help you regain muscle strength and increase your range of motion. Your therapist may also recommend certain exercises to help your wrist regain its full functioning.
7. Visit Your Doctor for a Follow-Up
Keep your appointments with your doctor and get medical attention right away if you experience any of the following:
- Increasing pain
- Persistent swelling
- Numbness in your hand, fingers or wrist
- Fingers that are turning pale
- Any deformity at the wrist
Learn More About Recovering From a Broken or Fractured Distal Radius
At OrthoBethesda, we understand the pain you may have when you injure your wrist. Give us a call to speak with our orthopedic doctors who specialize in treating the hand and arm. We’re fully equipped and prepared to help you treat your wrist for fast, effective pain relief and full recovery.
Casts and splints are orthopedic devices that are used to protect and support broken or injured bones and joints. They help to immobilize the injured limb to keep the bone in place until it fully heals.
Casts differ from splints because they provide more support and protection for a limb that is injured or broken. They are made from materials like plaster or fiberglass that can be easily molded to the shape of the injured arm or leg.
Splints, also known as half-casts, provide less support than casts, but are faster and easier to use. They also can be tightened or loosened easily if the swelling in the arm or leg increases or decreases.
Ready-made or off-the-shelf splints are available in many different sizes and shapes. In some cases, custom-designed splints must be used. Velcro straps make it easier for the patient or healthcare provider to put the splint on or take it off.
When are casts and splints used?
Casts and splints are used when a bone is broken. They can also be used following orthopedic surgery. Sometimes splints are used immediately following an injury due to swelling of the affected area. After the swelling goes down, then a full cast might be applied to the injured limb.
A cast might have to be replaced during the healing process if the injured area becomes less swollen and the cast gets looser. In that case, the cast might be replaced with a splint to provide more freedom of movement.
What types of casts and splints are available?
Casts are partly made from fiberglass or plaster, which form the hard layer that protects the injured limb and keeps it immobilized.
Fiberglass has several advantages compared to plaster. It weighs less, so the cast made from it will be lighter. More durable and porous, fiberglass allows air to flow in and out. Fiberglass is the better choice in case the limb must be X-rayed during the healing process. It is also available in a variety of colors.
Plaster costs less than fiberglass and is more malleable (is more easily shaped) than fiberglass in certain cases.
How is plaster and fiberglass casting done?
Before the casting material is applied, a stockinette is placed around the area that will be covered by the cast. Afterwards a layer of padding made of cotton or another soft material (Webril®) is rolled on to further protect the skin. The padding also provides elastic pressure to help healing.
Plaster comes in strips or rolls that are moistened and rolled on over the padding. Plaster materials are made from dry muslin that is treated with starch or dextrose and calcium sulfate.
After the process of applying the casting material is completed, the material will start to dry in about 10 to 15 minutes. The temperature of the skin might rise as the plaster is drying because of a chemical reaction that occurs. When plaster is used, it can take from 1 to 2 days for the cast to harden completely. The patient must be careful during this period because the plaster might break or crack while it is hardening. The cast will appear smooth and white after it hardens.
Like plaster, fiberglass materials come in rolls. Strips are moistened and applied to form the cast. The cast will appear rough after it has dried.
How do you relieve pain and swelling after the cast or splint is applied?
- Keep the injured arm or leg elevated for 1 to 3 days after the cast or splint is applied. The injured limb should be in a position higher than your heart to allow fluids to drain.
- Apply ice to the cast or splint at the site of the injury. The ice should be placed in an ice pack or a plastic bag to avoid direct contact with the cast or splint.
What are some tips for taking care of the cast?
- Avoid placing pressure or weight on the cast. If you have a leg injury and have a walking cast, make sure that the cast has hardened completely before you attempt to walk on it.
- Keep the cast clean and dry. A hair dryer with a cool setting may be used to dry a fiberglass cast if it becomes damp. Call your doctor if the cast does not dry or if the skin under the cast becomes wet.
- Cover or wrap the cast with a plastic bag before you take a shower or bath. Cast covers made from plastic with Velcro straps or rubber gaskets are sold at some medical supply stores or drug stores.
- Do not place any objects inside the cast. Avoid using lotions or powders on skin underneath the cast.
- Don’t attempt to scratch itchy skin under the cast with a sharp object. This might result in an infection if the skin is cut or broken.
- Call the doctor if you notice a strange or unpleasant smell coming from the cast. Perspiration or moisture under the cast can cause mold or mildew to grow. The skin can break down and become infected if it remains wet for a long time.
- Do not trim, file or break off rough areas around the edge of a plaster cast. A metal file may be used to smooth the rough edges of a fiberglass cast.
- Do not try to remove the cast yourself.
How are casts and splints removed?
Your doctor will remove the cast with a special cast saw when the bone has healed sufficiently. The cast saw has a flat, rounded metal blade that vibrates. It can cut through the cast without injuring the skin underneath. The doctor will cut the cast in several places, usually along both sides of the cast. The cast is then spread and opened and a special tool is used to lift it off. Scissors are used to cut through the protective padding and stockinette layers which then are removed.
What are some complications associated with casts and splints?
Complications can range from minor to severe and may vary according to the length of time that the cast is worn.
Pressure sores: A sore may develop on the skin under the cast. This can happen because the cast was too tight or did not fit correctly, causing excess pressure on one area.
Compartment syndrome: This is a major complication caused by a tight or rigid cast that constricts a swollen limb. When the pressure inside the cast builds up, it can cause damage to the muscles, nerves or blood vessels in the area covered by the cast. The damage may be permanent if it is not discovered and treated promptly. Call your doctor or visit the emergency room immediately if you notice any of the following symptoms.
- Numbness or tingling in the affected limb.
- Cold or pale skin or skin with a bluish tinge.
- Burning or stinging.
- Increased pain or swelling.
Last reviewed by a Cleveland Clinic medical professional on 04/17/2017.
- American Academy of Orthopedic Surgeons. Care of Casts and Splints (http://orthoinfo.aaos.org/topic.cfm?topic=A00095) Accessed 4/27/2017.
- American Family Physicians. Principles of Casting and Splinting (http://www.aafp.org/afp/2009/0101/p16.html?printable=afp) Accessed 4/27/2017.
- Hutson AM, Rovinsky D. Chapter 76. Casts and Splints. In: Reichman EF, Simon RR, eds. Emergency Medicine Procedures. New York: McGraw-Hill; 2004.
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Brett Sears, PT, MDT, is a physical therapist with over 20 years of experience in orthopedic and hospital-based therapy.
Stuart Hershman, MD, is a board-certified spine surgeon. He specializes in spinal deformity and complex spinal reconstruction.
After an injury to your shoulder, elbow, or wrist, you might need to wear a sling on your arm to protect it while healing.
The shoulder sling keeps your arm against your body. It prevents you from moving your arm too much as you heal after an injury. If you wear it the wrong way, you might delay healing or injure your arm more.
This article goes over when you need a shoulder sling, how to wear it correctly, and mistakes to avoid.
Common Reasons for a Sling
There are many instances where you may need to keep your arm in a sling after an injury. These include:
- After a fracture: If you have a shoulder fracture, elbow fracture, or wrist fracture, it’s important to limit your arm movements to help bones heal properly. The sling keeps your arm still and in place.
- After shoulder surgery: You may need a sling so the muscles around your shoulder don’t contract too hard and disturb the healing process. After a rotator cuff surgery, using your muscles too vigorously can tear the repaired muscle. The sling prevents this from happening.
- After a stroke: A stroke is a serious injury and can cause paralysis in your arm, leg, or both. If your shoulder isn’t moving correctly, it may become painful as it hangs at your side. A sling helps support your arm and doesn’t let it pull uncomfortably at your shoulder.
Your healthcare provider might advise you to wear a sling as your body heals from other upper-body injuries or surgeries, too.
You might need to wear a shoulder sling after a stroke, shoulder surgery, or if you have a fracture of your shoulder, elbow, or wrist. The sling will keep your arm in place and can help your muscles heal properly.
How to Wear Your Sling
If you must wear a sling, it's important to wear it the right way to prevent fluid and blood from pooling in your hand and wrist and make sure your arm heals well.
To put on a shoulder sling correctly:
- Gently pull the sling over your arm and elbow. It should fit snugly around the elbow. Your hand should be at the very end of the sling. The end of the sling shouldn't cut into your wrist or hand. If your hand hangs at your wrist, your sling may be too small.
- Reach around your neck and grab the strap behind your elbow. Pull the strap around the back of your neck and push it through the loop near your hand.
- Tighten the straps to keep your hand and forearm elevated above the level of your elbow. This keeps blood and fluid from pooling in your hand and wrist.
- Attach the strap with the Velcro fasteners. You might want to put a small piece of soft cloth under the strap to make it more comfortable around your neck.
- Some slings have a strap that goes around your back to keep the elbow close to the body. If yours has one, reach behind to pull the strap around your back and fasten it near your hand. Make sure the strap isn't too tight. You should be able to fit two or three fingers between your body and the strap of the sling.
Your sling should fit comfortably and not feel tight. It should keep your shoulder, elbow, and wrist in a relaxed position so you can go about your day-to-day life.
Click Play to Learn How to Wear a Sling
This video has been medically reviewed by Oluseun Olufade, MD.
There are common mistakes people make when wearing a shoulder sling. If you use it the wrong way, it can cause discomfort and slow down the healing process. Your healthcare provider or physical therapist can help you avoid these pitfalls.
Sling Is Too Loose
If the sling doesn't support your shoulder, elbow, and wrist, it won't keep your arm in place. This can put unnecessary stress and strain on your arm.
Make sure the sling supports your arm and forearm, and keep your elbow at a 90-degree angle. If your elbow is too straight, the sling may be too loose.
Sling Is Too Tight
A sling that's too tight may limit blood flow to and from your elbow and hand. This blocks oxygen from getting to your tissues and can damage your arm, hand, or fingers.
Ask your healthcare provider or physical therapist to adjust your sling if your arm, hand, or fingers:
- Feel numb
- Feel cold
- Turn blue
Arm Is Hanging Too Low
When you wear your shoulder sling, your arm shouldn't hang too low. If it does, the weight of your arm may put more stress and strain on the healing arm and shoulder. Plus, your arm may suddenly fall out of the sling if it's hanging too low.
Keep your elbow bent at 90 degrees while you wear your sling. The sling should support your arm firmly against your body without lifting. Your shoulder should be in a stable and neutral position, not higher or lower than normal.
If you're not sure if the sling is on properly, ask your healthcare provider or physical therapist to adjust it.
You're Not Exercising Neighboring Muscles
The goal of your sling is to protect your shoulder and arm as it heals. But you should still use some of the muscles of your arm and hand during recovery.
The sling is designed to limit your shoulder mobility. Because of that, it can decrease your arm’s range of motion (ROM) and strength—unless you take steps to avoid that.
During recovery, your healthcare provider might tell you to take off the sling and do no-impact pendulum circle exercises two to three times per day. This helps keep your joints mobile.
Also, handgrip exercises with therapy putty can provide resistance and help your wrist and forearm get stronger.
Just because you have a shoulder sling doesn't mean you should let your surrounding muscles get weaker. Talk to your healthcare provider about doing safe exercises to keep your wrist, hands, and forearms from getting too weak.
Wearing a shoulder sling may be key to helping your arm or shoulder heal after an upper body injury or surgery. You might need to wear a sling after a stroke or if you have an elbow or shoulder fracture. But it's important to use it correctly.
If you do, you can prevent further injury and help your muscles heal faster. Make sure your sling is not too loose or too tight, and keep your arm next to your body.
A Word From Verywell
All the straps and loops can cause a bit of anxiety if you have to wear a sling. With practice, you’ll be able to comfortably wear it to let your arm properly and safely heal. If you feel you need more help with your sling, see your healthcare provider or physical therapist.
Once your injury has healed, you may need to do exercises to improve your arm strength and range of motion. Improving mobility can help you return to your condition before the injury.
No one plans for a broken bone, but they happen. Almost everyone will suffer at least one fracture in their lifetime, and most people with have several fractures. The entire process is very painful, especially if the fracture requires surgery. Putting on a cast can also be painful, as it must be tight enough to keep the limb from moving and the broken bones from shifting during the healing process, yet it must be loose enough to allow circulation and prevent excess pressure on the nerves. This is a fine balance for an orthopedist to walk.
Yet, unfortunately many orthopedists improperly cast patients by making the cast too tight. This can cause serious injuries to a patient’s limb, particularly when the cast is left on for weeks or even months. Here at Kuhlman Law, LLC, we handle orthopedic medical malpractice claims in Minneapolis, St. Paul, Duluth, and anywhere throughout the state of Minnesota. Call us today by dialing (612) 444-3374 to learn more how we can help you protect your rights.
Causes of Casting a Fracture too Tight
Orthopedists and the nurses, nurse practitioners, and technicians assisting in placing a cast on a fractured limb are all trained how to do so properly to avoid secondary injuries, or injuries caused by the medical treatment. However, some fractures can be very complex and require special attention, experience, and often extra imaging studies to ensure the proper result. This is particularly true in crushing injuries, where several bones may be broken in a small area, or in fractures requiring surgery with hardware.
Outside of the complexity of the injury, there are several common causes of casting a fracture too tight due to Minnesota medical malpractice which include the following:
- Failing to wait until swelling has stopped increasing;
- Using the wrong material for the type of fracture;
- Improperly packing the cast;
- Wrapping the cast too tight;
- Failing to take into account future swelling or reduction of swelling;
- Failing to consider that the limb is weight bearing;
- Failing to gauge how much the muscles in the limb will contract or retract when flexing;
- Failing to consider how gravity will cause the limb to pool excess swelling from other areas of the injury;
- Not identifying landmarks where nerves and vessels are;
- Rushing to put on the cast to move on to the next patient;
- Not considering how much a child may grow while in the cast if it is a long-term cast; and
- Many other causes.
Common Injuries from Casting a Broken Bone Excessively Tight
While it may not seem like too much of an issue, putting a cast on a patient too tight can actually cause permanent damage. This is because a cast that is too tight will restrict blood flow to the limb, will put excessive pressure on the nerves, and may even cause atrophy of the muscles or tendons in the limb. This can cause some of the following damages due to Minnesota orthopedic medical malpractice:
- Permanent nerve damage resulting in loss of sensation, loss of motor movement, constant pain, and/or constant tingling;
- Severe damage to the vital blood vessel structures, including in loss of blood flow, loss of oxygen, loss of strength;
- Damage to muscles and tendons which cause them to wither away or die slowly;
- Malformation of the broken bones by causing them to bow inwards due to the outwards pressure;
- Compressing and damaging tendons and ligaments making them weaker and work less effectively;
- Amputation if the limb is cast too tight for too long and begins to die; and
- Many other causes of medical malpractice.
Casting a Fractured or Broken Bone Too Tight is Very Serious Orthopedic Medical Malpractice in Minnesota
If you or a loved one have been injured due to the medical malpractice of a healthcare provider such as a doctor, nurse, hospital, or other health care service professional, call Kuhlman Law, LLC for a FREE consultation by dialing (612) 444-3374 to learn what your rights to compensation may be. If we accept your case, we will conduct a thorough review of your case and advise you whether there may have been a serious medical mistake causing your injury. There is no risk, and you do not owe us money unless we win your case.
As a child, having a cast or splint on a broken arm or leg might seem cool. As an adult, it’s frustrating. Casts and splints are hard wraps used to help a broken bone, torn ligament, tendon, or other tissue heal. Casts and splints relieve some pain and reduce swelling, too. They help it heal by keeping broken ends together and as straight as possible. Casts and splints help keep the injured area from moving. This helps the injury heal faster without risk of repeated injury.
The amount of time you’ll need to wear your cast or splint depends on the type of injury. Also, it depends on the seriousness of the injury. If you keep a cast in good condition, it can stay on for several weeks. Your doctor will tell you when it’s ready to come off. A splint usually stays on for several days to a week. If your injury causes swelling, you may need a splint until the swelling goes away. You may still need a cast after swelling goes down. Also, if your injury is swollen, both splints and casts may need to be adjusted in the first few days. As the swelling goes down, a cast or splint may become too loose. If swelling increases, the splint or cast may become too tight.
Path to improved wellness
Almost all broken bones, injured tendons, and ligaments cause pain. Casts and splints are designed to relieve pain by limiting your movement. Your pain should become less severe each day after getting your cast or splint.
Casts and splints are different, too. Casts are custom-made with fiberglass or plaster. A cast wraps all the way around an injury and can only be removed in the doctor’s office.
A splint is like a half cast. The hard part of a splint does not wrap all the way around the injured area like it does with a cast. Instead, there are usually 2 hard areas connected with an elastic bandage or other material that hold the splint in place. Unlike casts, splints can be easily removed or adjusted. Splints can be custom-made from fiberglass or plaster, or they may be ready-made. Splints come in lots of shapes and sizes for different injuries.
With a cast and splint, your pain should become less severe each day after getting it. To relieve discomfort that can occur when you get a cast or splint, raise the cast or splint above your heart. You can do this by propping your arm or leg on pillows (especially in the first 48 hours after you first get the cast). You will have to lie down if the cast is on your leg. This may reduce pain and swelling. Flexing your fingers or wiggling the toes of the affected limb also helps reduced swelling and discomfort.
- Casts cannot get wet. However, covering your cast with a plastic bag and holding it in place with a rubber band can help keep it dry when bathing and showering. You can also buy a waterproof cast cover. Never swim with a cast.
- The skin inside your cast can get itchy. Do not use makeshift materials to relieve the itch (such as a sharp object or the heat from a hair dryer). Ask your doctor for safe methods to relieve the itch.
- Try to keep the area around the edge of the cast clean and moisturized.
- Wiggle your fingers or toes while wearing a cast or splint. This helps with circulation.
- You can apply ice for 15 to 30 minutes over a cast or splint. However, the ice should be covered to prevent getting the cast or splint wet.
- Ask your doctor whether you can take over-the-counter or prescription pain medicine.
Things to consider
Call your doctor if your pain gets worse after getting the cast or splint. New pain or numbness may mean that the cast or splint is too tight. You should also call your doctor right away if you have new pain that develops in another area (for example, pain in your fingers or forearm if you have a wrist or thumb injury, or pain in your toes or calf if you have an ankle or foot injury).
- Most casts shouldn’t get wet. If you get a cast wet, irritation and infection of the skin could develop. Talk to your doctor about how to care for your cast. If the cast does get wet, you may be able to dry out the inside padding with a hair dryer (use a low heat setting and blow the air through the outside of the cast).
- Check the skin around the cast for irritation, chafing or sores. If your skin itches underneath the cast, don’t slip anything sharp or pointed inside the cast to try and itch the spot. This could damage your skin and you could get an infection.
- Check with your doctor if a bad smell is coming from the inside of your cast. This may mean you have an infection.
- See your doctor if you experience bleeding inside the area covered by a cast or splint.
- Don’t break off or file down any part of the cast. This could weaken the cast and make it more likely to crack or break. If there is an area of the cast that is uncomfortable, try padding it with a small towel or soft adhesive tape.
- If you have a leg or foot cast, don’t walk on it unless your doctor gives you permission. A cast may not be strong enough to bear weight.
- Avoid getting dirt or sand inside a cast or splint.
- Don’t put powders or deodorants inside your cast or splint.
- Don’t pick at the materials of your cast or splint. A damaged cast or splint is ineffective.
Eventually, your doctor will remove your cast or splint. Your doctor can remove the splint easily by unwrapping it. For casts, your doctor will use a special cast saw and blade that cuts through the outer layer of the cast safely. Never remove the cast yourself or use any cutting material to remove it. You could experience a serious injury to your skin, blood vessels, and injured area.
Technically speaking, the answer to the question “can broken bones heal without a cast?” is yes. Assuming conditions are just right, a broken bone can heal without a cast. However, (and very importantly) it doesn’t work in all cases. Likewise, a broken bone left to heal without a cast may heal improperly. So perhaps instead of asking “can broken bones heal without a cast?”, the more useful question to answer is “do I need to get a cast?”
How to Heal a Broken Bone
Before answering the question, “do I need to get a cast?” It helps to consider how to heal a broken bone. Just as a cut on the skin will heal by itself, so too will a bone. If the cut is small, and the edges of the cut are close together, the skin will close itself up with time. The larger the cut, the longer the healing process will take, and the larger the scar will be. If there is considerable pressure placed on the skin, the cut will take even longer to heal, and the scar may be bigger afterwards.
The skin cut analogy can be used to help us understand how to heal a broken bone. If the break is small, and the edges are close together, it is more likely that the bone can knit itself together. On the other hand, if the sections of remaining bone are far apart and/or there is excessive pressure on the bone, the healing process of the broken bone will take longer. It is also more likely that the healed bone will be abnormal (like a large scar).
Thus, the best way to ensure a broken bone heals properly is to create the right conditions for the bone to heal. The bones should be immobilized, or not be able to move relative to one another. Since it takes weeks for bone to heal, the bone needs to be immobilized the entire time.
Lastly, the body needs to have optimal nutrients for the healing to occur. Bone healing requires calcium, natural hormones, vitamins, and adequate nutrition. Nutritional deficiencies, vitamin deficiencies, and certain chronic diseases can interfere with the natural process of bone healing. 1 However, properly treating these problems can help restore natural bone healing.
Do I Need a Cast for a Broken Bone?
When you consider what a bone needs to properly heal itself after being broken, a cast makes good sense in many cases. A cast holds the broken bones in alignment and close to one another for several weeks, until the cast is removed. If the broken bone is in the leg, people usually are also given crutches or even a wheelchair to keep weight off of the healing bone.
A broken bone cast is required for longer bones such as the arms and legs. Some also may need to get a cast for certain broken bones in the torso, such as ribs, collarbones, and shoulders. On the other hand, people with finger fractures may not need to get a cast if the finger can be held in place with a splint or tape.
In essence, a broken bone cast is required if a rigid cast can create the right conditions for the broken bone to heal (see How to Heal a Broken Bone above).
Broken Bone Treatment Options
A cast is one option for treating a broken bone, but it is not the only treatment option. Other broken bone treatment options include splinting, taping, bracing, placing the affected bones in a sling, and surgery. As mentioned, finger fractures are often treated with taping. Typically, a process called “buddy taping” is used in which the broken finger is taped together with one or both surrounding fingers. The hand may be further immobilized with a brace.
An air splint is a temporary method of holding the bones together until a cast can be placed. An air splint is a long air-filled tube that provides some, but not full immobilization.
Some bones and some fractures are best treated with surgery. An orthopedic surgeon may use screws and plates to hold the broken bones in careful alignment with one another. The hardware can then be removed once the bone has healed.
Do You Have a Broken Bone?
Broken bones are treated by orthopedic surgeons. They are the experts in all broken bone treatment options, from taping to casting to surgery. Whether you need to get a cast or not, a broken bone should be evaluated and treated by an orthopedic surgeon. The orthopedic surgeons at Regional Orthopedics are leading specialists in this regard — they know how to heal broken bone inside and out.
If you want to learn more about broken bone treatment options, contact Regional Orthopedics for a consultation.
The short arm cast is also known as the below-elbow cast. This is a frequently used circumferential immobilization cast of the forearm and wrist made of either synthetic material or plaster of Paris, used as a treatment for some local fractures and soft tissue injuries.
Examples of injuries for which a short arm cast might be appropriate include the following:
distal forearm fractures,
carpal and wrist injuries,
some metacarpal fractures,
pediatric buckle and minimally displaced distal radius fractures,
minimally displaced fractures of the distal radius in adults, and
immobilization of the forearm after surgery.
A short arm cast is not indicated when the needed immobilization requires avoiding supination and pronation movements. In these cases a longer type of immobilization should be used, such as a Muenster cast, a long arm cast (also known as the above-elbow cast), or a sugar-tong splint. 1
Variations of short arm casts are used for specific injuries (eg, thumb spica cast for scaphoid fractures).
Severe soft tissue injuries that accompany some fractures have the potential to produce compartment syndromes and are a contraindication for this type of casting. These injuries could require immediate surgery or the use of noncircumferential immobilization (eg, back slab splinting). 2
Steps for immobilization
Educate the patient and obtain informed consent
Review with the patient the indications for the immobilization and explain the risks, benefits, alternatives, possible complications, and expected care during and after the cast application.
Most parents just trust and take the doctor’s word for it that the right kind of splint has been put on their child when they have a broken arm. The fact is that splints put on by clinics, ERs, and other health professionals often do more harm than good. Fortunately the harm is minor and temporary in almost every case, but these tips will help you avoid unnecessary discomfort for your child.
Broken arms need splints, but as a parent you should maintain some healthy skepticism and paranoia about how your child’s arm is immobilized, especially coming straight from the emergency room
The following are clues to a bad splint you can use if your child just had one put on in the ER or other clinic. Most orthopaedic surgeons should know better, but sometimes the office staff puts the splint on, so keep these in mind regardless of who put the splint on your child.
Clues to a bad splint – check the fingers!
Look at the fingers – are they swollen, purple? Can your child feel them and move them? For most casts and splints, the fingers should be completely free.
The cast material should stop in the middle of the palm on the palm side, and just shy of the big knuckles on the back side of the hand.
Most casts and splints are put on to stop the wrist or forearm from moving. Sometimes a special splint is made to stop the thumb from moving, but the other fingers should be free.
Even in a bad wrist fracture the fingers should remain free. It only takes a few hours for the fingers to stiffen up and get worse. This makes pain, swelling, and discomfort worse.
Another clue to a bad splint – check for tightness!
The splint should not be tight.
It may feel snug, but not tight to the point of being uncomfortable.
This is why casts (hard, fiberglass or plaster ones that go all the way around the arm) are never put on in the emergency room. The arm will swell a few days after the injury, making the cast tighter.
Tightness in a splint or cast is dangerous because as the swelling increases, this puts pressure on the blood flow to the arm, which can cause pain, nerve damage, and in the worst cases, gangrene.
Even worse, most kids are not complainers when they get a cast – they figure whatever they feel must be normal. This is a recipe for disaster if parents aren’t paying close attention.
Usually the tightness of a splint is fixed easily by either cutting or unwrapping the ace wrap on the outside. Ask your doctor before you do this.
Final clue to a bad splint – watch for pain!
Pain is never normal in a cast or splint.
Pain could be coming from any one or all of the following:
- skin rubbing on the hard material of the splint
- wet skin getting irritated
- too much pressure on the muscles, blood flow, and nerves from a tight cast
- cast is so tight that blood can’t drain as well from the hand
- pieces of the fractured bone are shifting and moving
If your child has pain in a cast or splint that’s uncontrolled by mild oral medicines and elevating the hand and arm above his heart, call your doctor right away.
It’s always worth it to get the splint removed and check for any problems rather than let something get worse, with potentially irreversible consequences later.
There are different types of fractures. Your child’s treatment will depend on the type of fracture, and where it is.
Key points to remember about fracture
- a fracture is a break in the bone
- there are different types of fractures
- your child’s treatment will depend on the type of fracture, and where it is
- make sure your child goes to all follow-up appointments with your doctor
- your child will often need more x-rays to check healing and bone position
- which bone is broken and how severe the break is will affect how long the fracture takes to heal
Most children with simple fractures can have their treatment in the emergency department and go home from there.
What is a fracture?
A fracture is a break in the bone. There are many different types and names of fractures.
There is a break in the bone but no damage to the skin or tissue.
Open or compound fracture
There is a break in the bone and damage to the skin or tissues near the fracture. Having damage to the skin means there is a risk of bacteria getting into the bone. This can cause a bone infection.
Greenstick or buckle fracture
This is a common injury in children because a child’s bone can bend or buckle more easily than an adult’s, without completely breaking.
How is a fracture diagnosed?
Your child will need an x-ray to see where the fracture is, what type of fracture it is and whether or not the bones are in line.
How can first aid help your child with a fracture?
Keep the injured arm or leg still. A splint can help keep the injured part still. Someone trained in first aid may be able to put a splint on your child.
You can support the injured arm or leg with a pillow or sling.
Your child will need pain relief. If they are able to swallow, you can give paracetamol or ibuprofen to make them more comfortable. You must follow the dosage instructions on the bottle. It is dangerous to give more than the recommended dose.
If your child is in a lot of pain, call an ambulance.
What kind of treatment will my child have for their fracture?
Different fractures need different treatments. Your child’s doctor will discuss with you what treatment is necessary for your child’s fracture.
Usually, the treatment for fractures in children is a plaster cast. Sometimes, after a fracture, there can be swelling so your child may need a splint (half a cast) for the first few days. When the swelling goes down, a nurse or doctor will put a carefully shaped plaster cast on to hold the bones in the correct position.
Manipulation to move the bones into a better position
If your child has a fracture where the bone ends are not lined up (displaced), a doctor or nurse may need to move the bones into a better position before putting on the plaster cast. This is called manipulation and your child will need sedation or a general anaesthetic.
Sometimes your child will need an operation to fix the fracture with screws, nails, plates or wires. This surgery is called an ORIF (open reduction and internal fixation). Your child will need a general anaesthetic. This surgery may be necessary for fractures:
- into a joint – an articular fracture
- involving a growth plate (the cartilage or connective tissue at the ends of long bones in growing children) – this is called an epiphyseal fracture
- through abnormal bone – a pathologic fracture
- where there is significant displacement and the bones can’t be lined up (reduced) or won’t stay lined up after manipulation
- where there is damage to the skin – an open fracture
Sometimes, your child will need traction to keep the bone in position. This involves the use of pulleys, weights and bed rest.
Will my child have to stay in hospital for their fracture treatment?
The time your child is in hospital will depend on:
- the bone(s) involved
- the type of fracture
- the treatment they need
- the need for pain relief
- how much swelling your child has
Most children with simple fractures can have their treatment in the emergency department and go home from there.
If the fracture is more severe, the orthopaedic team (bone specialists) will keep your child in hospital to watch the swelling and keep the arm or leg raised. They will also give your child stronger pain relief if they need it.
How long will it take for my child’s fracture to heal?
Children heal differently. Your child’s healing depends on where the fracture is and how severe the break is. For example, a simple buckle fracture will need a plaster cast for 2 to 3 weeks and be almost completely healed in 4 weeks. Children heal in about half the time it takes an adult to heal from a similar injury. Often fractures in bones that are growing will correct their own shape (‘remodel’). This means that even if your child’s bones are not quite in line, they will usually correct themselves with time.
How can I care for my child with a fracture at home?
In the first few days, your child may have swelling and pain in their fractured limb. To reduce the swelling and discomfort when your child is resting, raise the limb by resting it on a pillow.
If your child has a fractured arm, they should wear an arm sling when they are up and about.
If your child has a fractured leg, they will need crutches. Remember that in the first few days, your child should rest and keep their leg raised. They should only use crutches for short periods, such as getting up to go to the toilet. Follow the instructions of the medical team about when your child stands or walks.
Your child will usually need pain relief for the first few days after going home from hospital. Your child’s nurse or doctor should talk to you about pain relief before you go home.
You should ask your child’s doctor when it is OK for your child to return to normal activities such as school and sport.
When should I seek help for my child’s fracture?
After going home, you should take your child back to the emergency department or contact your medical team urgently if your child:
- complains of pain that is getting worse even with pain relief and raising the fractured arm or leg
- has a hand or foot that is going cold, pale or blue or becoming more swollen
- complains of fuzziness, numbness, pins and needles or tingling in the fractured arm or leg or in their toes or fingers
- cannot move their toes or fingers
If your child’s plaster becomes cracked, broken, soft or loose, or it is rubbing, contact your medical team. If it is a leg plaster, your child shouldn’t walk on it and should use crutches.
What follow-up is required for my child’s fracture?
It is very important that your child goes to all their follow-up appointments.
Your child will usually need a fracture clinic appointment 5 to 14 days after leaving hospital. At this appointment, your child may have another x-ray to make sure the bone is healing and is in place. Your child will usually need to go to several more appointments at a fracture clinic to make sure the break is healing.
Ask your nurse or doctor for instructions for your child’s follow-up before you leave hospital.
Firstly a stockinette is applied to the skin to protect it from the casting materials. Then a layer of cast padding is rolled on to further protect the skin.
The plaster bandages are then rolled on whilst they are still wet. The cast will usually start to harden within 10-15 minutes, although it takes much longer to fully dry out. It is important to be really careful with a cast for the first 24-48 hours until it is completely dry and hard.
There are certain things that need to be done to protect the cast and make sure it lasts as long as it is necessary.
- By far the most important thing is to keep the cast completely dry! Cast covers can be purchased for use whilst bathing. Generally, it is recommended to bath rather than shower and hang the casted limb over the edge.
- Do not lean or put weight on the cast as this may cause it to break.
- Do not put anything down the cast, including trying to itch the skin beneath it. This could damage the inside of the cast or the skin which could lead to infection.
How Long Does a Cast Stay on For?
In general, plaster casts are applied for between 6 and 8 weeks, although it can be more or less depending on the severity and location of the fracture.
How is a Fracture Cast Removed?
The cast is removed using a cast saw and another specialised tool. The cast saw is designed to cut the cast, but not the skin underneath. After the cast has been cut, usually along both sides, the tool is then used to spread and list the cast-off. The stockinette and cast padding is then cut off.
After the Cast is Removed
Once the cast is removed you may notice that the body part which was casted looks different to the other side. It may appear smaller and paler and the hair growth may also be different. This is all quite normal and is due to muscle wasting and a lack of sunlight to the skin. The colour and hair growth will slowly return to normal.
Muscle wasting occurs because the body part has been immobilised and so the muscles have not been working. A rehabilitation programme should be prescribed for you to help regain muscle strength and size.
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