1. How should I look after my cast?

Keep your cast as dry as possible to prevent skin irritation and odour. The inside of the cast should be dried with a hair drier (cool setting) in the morning, evening, after bathing or exercise, and additionally as often as you like - this will help prevent itching and reduce skin irritation.

 

When bathing or showering, cover the cast with a plastic bag or cling wrap. Hold your hand up in the shower so that water does not run down inside the cast. If your cast does get wet, towel blot the cast, then use a blow dryer (cool setting) until it is completely dry. Do not trim or re-shape your cast. The cast has been custom designed to provide maximum support during healing. Cutting or altering the cast may lengthen your recovery time. If the padding has shifted and the edge of the cast rubs against your skin, you may be able to pad it with moleskin. However, if the cast feels as though it is tight or is irritating your skin, please contact the rooms.

 

1. Never insert anything under your cast to scratch an itch - you could cause severe skin injury.

2. Avoid getting dirt or other foreign particles under your cast. Worsening pain or skin irritation are causes for orthopaedic review.

3. If any of these problems occur, contact the office /trauma unit (after hours) immediately:

4. Cast becomes uncomfortably loose or slips.

5. Cast rubs or presses against your skin and causes irritation.

6. Cast becomes uncomfortably snug or tight.

7. Fingers become swollen, numb or tingly, difficult to move, or become cool or discoloured (bluish or whitish tinge).

8. Moderate discomfort develops into severe or constant pain, unrelieved by elevation of the affected part (this may represent an early compartment syndrome, which requires cast removal and further orthopaedic surgical management)

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2. Your Pin Care

Stainless steel pins (Kirschner wires) are sometimes left protruding through the skin or they are buried just underneath the skin. Pins of an external fixator also protrude from the skin. In cases of exposed pins (usually they are covered by dressings and/or a cast), must be kept clean and protected from catching on sheets or clothing. Kirschner wires are usually removed at four weeks or earlier. External fixators may remain on for as long as 8 to 12 weeks and the risk of the problems is therefore higher in these cases. Protruding pins may be easily removed in the rooms, buried pins and external fixators may require removal in theatre. Pins are usually best removed under light general anaesthetic in the case of paediatric patients.

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3. ​How to care for my wound? 

Wound care be summarised in two statements: "keep it high and keep it dry." + "move it but don't use it."

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Keep it dry

Wounds do best if kept clean and dry the dressing over the wound is occlusive and therefore designed to form a barrier between the wound and the outside world. The dressing is furthermore designed to soak up any normal fluid drainage from a postsurgical wound. If there is excessive bleeding or fluid drainage and the dressing becomes sodden or there is fluid leaking from underneath the dressing, the dressing should be changed. This is usually best performed by a medical professional (orthopaedic surgeon/general practitioner/wound care sister) in order to maintain sterility as far as possible and in order to be able to refer you on as appropriate if excessive bleeding or infection is suspected. Please contact the rooms during office hours or the trauma unit after hours in this regard. Under no circumstances should you apply any lotions or ointments to the wound. The wound should not be left open until the sutures been removed and skin integrity has been confirmed. Please do not remove the sutures yourself as this may contaminate the wound.

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After surgery, the affected limb is frequently placed into a compression bandage in order to prevent excessive swelling and bleeding around the surgical site. You will also be instructed to elevate the limb as much as possible during the first three days post surgery and to apply ice packs as appropriate. A swollen wound increases the risk of post-operative infection as well as dehiscence (opening up of the suture line). You will be given instructions for the bulky compression bandage (if in place) to be debulked by the treating physiotherapist after 48 hours post-surgery. You will then often be placed into a thinner compression garment until your wound check.

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Move it, don't use it

Orthopaedic surgical procedures, especially around joints should result in enough stability to allow gentle graduated range of motion exercises, beginning on the day of surgery. Physiotherapy assistance is imperative in this regard. Under some circumstances, no movement of a certain joint will be allowed and in these cases, the patient will be placed into an appropriate splint and give specific instructions. 

 

Moving the joints provides a significantly better outcome, both from the point of view of achieving better function earlier post surgery, as well as mobilising swelling and thereby decreasing chances of developing wound problems. It is imperative that the patient realises the difference between being asked to perform careful, graduated range of motion exercises with physiotherapy assistance (which may then be repeated unsupervised once learnt) and the actual use of the limb (picking up loads with the upper limb or mobilising with weight-bearing on the lower limb).

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Using the limb normally too soon post surgery may have disastrous consequences and initiation of functional rehabilitation should always be cleared with the treating orthopaedic surgeon. Infection should be suspected if you develop increasing swelling, pain and redness around the wound, which does not settle with elevation and routine pain control. Infection usually only manifests at between five and seven days post surgery, but this may vary. Drainage from a wound is normal post surgery and does not constitute infection. Often the blood soaks into the dressing and may take on a greenish colour. This does not mean that there is pus in the dressing.

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Other wound issues which may concern the patient are bruising around the surgical site: 

• This is normal and should be expected post-surgery. The bruising usually changes colour from purple to yellow over the course of two weeks. The development of white patches around a wound, which is usually due to excessive moisture underneath a dressing, may be addressed with local treatment and application of a dry dressing.

• Red patches of skin should raise concerns about infection; however, they may also be due to irritation or dermatitis caused by the adhesive agent in the dressing. If this is the case, local treatment and a changed to a hypoallergenic dressing may resolve the issue.

• Chronic management of a well healed wound includes digital manipulation and massage as well as application of moisturising ointments. Instructions in this regard will be given to you by the treating physiotherapist.

• Desensitisation of a sensitive scar may also be required. Please be aware that scars may be hyper sensitive to sunlight for the first few months and you should apply sunblock whenever appropriate.

• Smoking increases your infection risk significantly and also increases the risk that your bones will not heal.

• Please contact the rooms during office hours or the trauma unit after hours if you develop wound problems

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