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J Am Acad Orthop Surg, Vol 16, No 1, January 2008, 30-40.
© 2008 the American Academy of Orthopaedic Surgeons
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Cast and Splint Immobilization: Complications

Matthew Halanski, MD and Kenneth J. Noonan, MD

Dr. Halanski is Staff Orthopaedist, Helen DeVos Children’s Hospital, Grand Rapids, MI. Dr. Noonan is Associate Professor, University of Wisconsin, Madison, WI.

Dr. Halanski or a member of his immediate family has received research or institutional support from the University of Wisconsin and the Wisconsin Orthopaedic Society. Dr. Noonan or a member of his immediate family serves as a consultant to or is an employee of Biomet.

Reprint requests: Dr. Noonan, 600 Highland Avenue, Rm K4-731, Madison, WI 53792.

During the past three decades, internal fixation has become increasingly popular for fracture management and limb reconstruction. As a result, during their training, orthopaedic surgeons receive less formal instruction in the art of extremity immobilization and cast application and removal. Casting is not without risks and complications (eg, stiffness, pressure sores, compartment syndrome); the risk of morbidity is higher when casts are applied by less experienced practitioners. Certain materials and methods of ideal cast and splint application are recommended to prevent morbidity in the patient who is at high risk for complications with casting and splinting. Those at high risk include the obtunded or comatose multitrauma patient, the patient under anesthesia, the very young patient, the developmentally delayed patient, and the patient with spasticity.




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