Different Types of Fracture Casting

Types of Upper Limb Casts

• Shoulder Spica Cast
• Long Arm Cast
• Short Arm Cast
• Hanging Arm Cast
• Thumb Spica Cast

Shoulder Spica Cast

This type of cast is used to immobilize fractures of the upper part of the humerus bone or after surgeries on the shoulder.

Long Arm Cast

This type of cast is used for fractures of the elbow, forearm bones, and also after some surgical procedures. The cast starts from the upper arm and extends to the end of the hand, near the fingers. The purpose is to immobilize the elbow, forearm, and wrist to help fracture healing.

In this cast, the fingers (except the wrist) are free and can move easily, which prevents stiffness of the finger joints. The angle of elbow bending, forearm rotation, and wrist position (bent or straight) vary depending on the fracture type and the doctor's decision. Generally, the duration of cast use depends on the injury type and healing speed, and the doctor decides when to remove the cast.

Short Arm Cast

This cast starts below the elbow, covering the forearm and wrist, ending where the previous cast ends.
It is used for fractures of the distal radius bone and after surgeries related to this area, wrist, and ulna bone. When using short or long arm casts, the thumb hole should be large enough so the thumb movement is not restricted.

Hanging Arm Cast

This type of cast is used to stabilize fractures of the humerus and helps maintain the correct bone position. For it to work properly, the arm must be hung from the neck. It is better if the patient sleeps semi-upright to prevent bone displacement during sleep. The cast starts from the bottom of the hand (under the fingers) and extends up to the fracture site, including wrist, forearm, and elbow. In this cast, the wrist is slightly bent backward (15-20 degrees) and the elbow is bent at 90 degrees. The forearm is in a neutral position. Three cast rings are placed near the wrist to attach the hanging band. The weight of the arm and cast helps correct alignment and length of the humerus. Changing the ring positions can correct bone misalignments.
If correction of valgus deformity (outward deviation) is needed, the arm is attached to the inner ring; for varus deformity (inward deviation), to the outer ring; and if no deviation exists, the middle ring is used. To correct anterior or posterior deviation, the band length is adjusted accordingly.

Thumb Spica Cast

This cast is used to treat injuries related to the scaphoid bone, thumb ligaments, and after surgeries on the thumb and wrist. It comes in two types: long and short.
Long cast: immobilizes not only the thumb and wrist but also the elbow. The elbow is fixed at 90 degrees for better healing.
Short cast: immobilizes only the thumb and wrist without involving the elbow. The cast angle varies based on the injury and doctor's recommendation.

Types of Lower Limb Casts

• Hip Spica Cast
• Long Leg Cast
• Cylinder Cast
• Short Leg Cast
• Patellar Tendon Bearing or PTB Cast
• Abduction Cast

Hip Spica Cast

This cast is usually used in surgeries related to the hip joint, especially in children. It is particularly applied after reduction of congenital hip dislocation or to treat fractures of the femur in children. The cast starts below the ribs and covers both legs. The affected leg is fully casted, and the other leg is either casted up to the knee or fully based on the doctor's decision. When both legs are fully casted, it is called a "full cast". If one leg is fully casted and the other up to the knee, it is called a "one and a half cast". Some side effects may be more common with this cast.
Preventing abdominal pressure:
When full-body casting is needed, to avoid abdominal pressure during eating and discomfort, a towel with appropriate thickness is placed from the lower abdomen (above the pubic area) to the chest before casting. This creates space for abdominal movement during eating. It is important to remove the towel before the cast fully hardens.

Preventing burns:
To avoid burns caused by extensive casting, use minimal layers and thickness. Also, areas prone to injury such as connections between limbs and trunk (around shoulder and pelvis) should be reinforced with supportive materials. This reduces cast weight and burn risk. To lighten the cast, a round or oval opening can be made on the abdomen area to reduce weight and prevent cracking.

Long Leg Cast

This cast treats various fractures including femur condyles, tibia condyles, leg bones (tibia and fibula), ankle fractures (both malleoli) or talus bone, and after some surgeries. It starts a few centimeters below the greater trochanter of the femur and extends to the sole of the foot, covering thigh, knee, leg, ankle, and foot. It reaches up to the metatarsophalangeal joints (between foot and toes) on the sole and up to the base of the toes on the dorsal foot. Joint immobilization angles depend on the doctor’s decision and injury type. For leg fractures, the ankle should be neutral (no varus, valgus, plantarflexion, or dorsiflexion). The knee may be immobilized straight (full extension) or bent (flexion).

Cylinder Cast

As the name suggests, this cast is shaped like a cylinder and covers the thigh, knee, and leg but does not immobilize the ankle or foot. It is used for patella fractures, lateral ligament injuries of the knee, and extensor mechanism injuries. It starts a few centimeters below the greater trochanter and ends above the ankle malleoli.

Short Leg Cast

This cast covers the leg, ankle, and foot. It extends from the back of the foot to the base of the toes and along the metatarsal bones. If toes are fractured and require immobilization, a plaster piece is used to hold them. The toe and foot joints should not be excessively bent backward. This cast is used for fractures of the ankle, talus, calcaneus, metatarsals, cuboid and cuneiform bones, as well as ligament injuries and post-surgical treatment of soft tissues and bones of the foot and toes. Typically, it is used for 4 to 6 weeks, but exact duration depends on doctor’s advice and patient recovery.

Patellar Tendon Bearing or PTB Cast

This special cast is designed to transfer part of the body weight to the patellar tendon when standing or walking. It is neither short nor long but covers from above the kneecap to the back of the leg. The front part acts like a shield covering the kneecap and tendon. This reduces pressure on the fracture site in the leg while walking or standing. Also, due to sufficient space behind the knee, knee motion range remains complete. This cast is used in certain stages of treatment for leg, ankle, and surrounding bone fractures.

Abduction Cast

Used to keep the lower limbs apart to achieve optimal results. Two long casts are applied and connected by a wooden bar while the lower limbs are abducted 40 degrees and internally rotated 20 degrees.