As an orthopedic surgeon working for many years, I have done numerous casts.
Before and after each fixation, patients would repeatedly ask many questions: Is it possible to fix without a cast? Do I need to avoid eating after fixation? What do I need to pay attention to? How to put the leg? How to apply ice? Can I get out of bed? Can I take a shower? Do I need to be hospitalized? When will I be reviewed?
At this time, many questions come to mind and many doubts need to be answered. Many patients go home to rest with their doubts, and if they are not observed carefully, some unnecessary complications may occur and cause a lot of pain.
The following are answers to frequently asked questions.
Is it okay to be unfixed?
I think most people are afraid of surgery, right? The doctor says fix it in a cast, you say it is not fixed, and then the fracture is displaced and you need surgery. Therefore, it is better not to ask such questions as can it be not fixed, except for those who are not afraid of surgery, of course.
Do I need to avoid eating?
This question is quite difficult to answer. First of all, I think that avoiding food is a Chinese medical term, avoiding spicy food, avoiding seafood and so on. I’m sorry as a Western orthopedic surgeon, I really can’t answer your question correctly and fully.
How do you put your leg?
This is one of the most important issues to be concerned about. After a fracture, the limb is usually very swollen, so you need to lie down and elevate the leg or arm with a quilt to help reduce the swelling. It is very important to reduce the swelling because we make the cast according to the current size of the limb, let’s say it is 41 (shoes have 41, legs don’t seem to), when the swelling is obvious, it may become 42 legs, the cast is relatively small, easy to crush the limb, we usually call fascial gap syndrome. Therefore, the first priority is to reduce swelling, how high is it appropriate to lift, lift higher than the heart on the line, conducive to venous and lymphatic fluid return, reduce the swelling of the limb.
How to apply ice?
The role of ice is to: strengthen collagen fibers, 2, make local vasoconstriction, 3, relax the muscles, 4, local anesthesia, pain relief, 5, anti-inflammatory, reduce the local metabolic rate, offset the inflammation caused by redness, swelling, heat, pain, and change the reaction process of the tissue. The method used is to cover the skin surface directly with ice, ice and water packs or ice packs containing special chemicals, making sure to avoid water leakage. At the beginning, the ice pack will feel locally cold, and eventually the local skin sensation will disappear temporarily, and when the local pain disappears, the cold therapy can be stopped. When the local pain disappears, the cold therapy can be stopped. The swelling usually decreases after 10 days or so, and the icing can be stopped.
Can I get out of bed?
Getting out of bed can cause severe swelling especially for lower limb fractures. In the early stage of swelling reduction, it is better to minimize getting out of bed. In the later stages of the fracture, weight bearing should be avoided to avoid displacement of the fracture.
Can I take a shower?
Most casts are afraid of water, and it is uncomfortable to get wet. It is necessary to keep the cast clean and prevent it from being impregnated and contaminated by water, urine and feces. Therefore, bathing without getting the cast wet is a technically difficult project. Please let me know if you have a good idea, after all, it is hard not to bathe for more than a month!
Do I need to be hospitalized?
If you are hospitalized, the usual treatment is to reduce the swelling. The method is elevation and icing, and sometimes sedative medication to reduce swelling.
How do I review it?
Early review is mainly to look at the swelling of the limb and to observe the circulation and nerve function of the limb: if there is pain or throbbing pain or numbness in the fixed limb, along with cyanosis, decreased temperature and swelling of the limb, it may indicate a circulatory disorder. This is something that needs to be dealt with immediately! Remove the cast immediately if necessary. If there is limited pain within the cast, prompt medical attention should also be sought to prevent localized cast pressure injury. The review after ten days is to observe if the cast is loose. Of course whether the fracture is displaced or not is something that needs to be observed at every review.
After your questions, it is my turn as a doctor to explain the precautions.
If there is pain or throbbing pain or numbness in the fixed extremity, along with cyanosis, decreased temperature, and swelling in the extremity of the finger or toe, it may indicate impaired blood circulation and must be reviewed immediately. Important things must be said three times!
Keep the cast intact: Do not press the cast or place the affected limb with the cast fixed on a hard object to prevent the creation of a depression to compress the skin. When elevating the affected limb, the main joint should be supported to prevent the cast from breaking due to joint movement. After the cast dries, it should be prevented from breaking. After the cast is completely dry and solid, it should be padded with soft pillows according to its concave and convex shape. Pay attention to functional exercise. Joints that are not immobilized by the cast need to be strengthened with activities. Even for the limbs wrapped in casts, muscle contraction exercises should be practiced according to the doctor’s requirements.
Plaster fixation is relatively simple, and as long as care is taken to reduce swelling early and careful observation, problems rarely occur. Of course, the choice between plaster fixation and surgery is a judgment of the doctor according to the specific condition. I hope the above words will be helpful to you.