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Review
. 2025 Jul 3:12:100244.
doi: 10.1016/j.jposna.2025.100244. eCollection 2025 Aug.

Common Cast Complications

Jessica A McGraw-Heinrich  1 , Jon C Wall  1 , Scott B Rosenfeld  2
Affiliations
Review

Common Cast Complications

Jessica A McGraw-Heinrich et al. J Pediatr Soc North Am. .

Abstract

Complications can arise from the application, wear, and removal of casts and splints. This text reviews common complications, risk factors, and prevention strategies while exploring the medical-legal implications of these complications. Being aware of common pitfalls can help reduce risk and promote optimal patient outcomes.

Key concepts: (1)Proper and judicious casting and splinting techniques are critical to prevent complications.(2)Thermal injuries can occur due to excessive curing heat and cast saw burns.(3)Poor cast molding can lead to skin sores and loss of fracture reduction.(4)Patients should be comfortable in their cast, and uncontrolled pain warrants investigation.

Keywords: Cast complications; Cast saw burn; Compartment syndrome; Loss of reduction; Pressure sore; Thermal injury.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Figure 1
Figure 1
Severe dermatitis in an infant treated with a spica cast. Increased fussiness in a young child should be further evaluated with cast removal to evaluate for underlying skin complications. Image courtesy of Matthew Halanski, MD.
Figure 2
Figure 2
Volar (A) and dorsal (B) hand burns secondary to thermal injury from splint immobilization of a buckle fracture. Images courtesy of Jud Karlen, MD.
Figure 3
Figure 3
Example of a dull cast saw blade (left) and new cast saw blade (right). Note the stuck-on cast material and dull teeth, which contribute to poor blade condition and increase the risk of thermal injury. Image courtesy of Jessica McGraw-Heinrich, MD.
Figure 4
Figure 4
A dorsal forearm cast-saw laceration secondary to cast bivalving. Image courtesy of Jessica McGraw-Heinrich, MD.
Figure 5
Figure 5
Heel pressure sores in two different infants. Image A shows an unstageable pressure sore with eschar in place. Image B shows full-thickness skin loss with exposure of the underlying calcaneus. The first sore resulted from a poorly fitting splint that slipped down, leading to pressure on the heel. Images courtesy of Matthew Halanski, MD.
Figure 6
Figure 6
Example of a posterior slab lower extremity splint that had loss of ankle dorsiflexion due to positioning not being maintained as the splint cured. This resulted in immobilization in equinus and wrinkling of splint material. Splint also had poor padding and the ends of splint were folded back, risking thermal injury. Image courtesy of Scott Rosenfeld, MD.
Figure 7
Figure 7
Deep skin sore caused by placement of a cast over an elastic hairband left in place at the patient's ankle (A; image courtesy of Scott Rosenfeld, MD). Superficial skin sore caused by a bracelet that was not removed prior to immobilization (B; image courtesy of Matthew Halanski, MD).
Figure 8
Figure 8
Examples of skin sores created by foreign bodies placed into casts. A and B are secondary to coins placed in arm casts. C is a severe pressure sore secondary to the placement of a Lincoln Log toy into the cast. Image D is secondary to a plastic toy placed into a leg cast. Images courtesy of Scott Rosenfeld, MD (A and C) and Matthew Halanski, MD (B and D).
Figure 9
Figure 9
When placing a spica cast for treatment of femoral shaft fractures, traction should be applied through the bare calf and the spica applied from the abdomen proximally to below the knee distally. Images courtesy of Scott Mubarak, MD.
Figure 10
Figure 10
Example of a poorly molded “banana” shaped cast which can predispose to loss of fracture reduction. Image courtesy of Valerie Parrish, PA-C.
See this image and copyright information in PMC

References

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