What are the complications associated with cast and splint immobilization, and how can they be prevented in high-risk patients?
Cast and splint immobilization carries significant risks of complications such as compartment syndrome and pressure sores, particularly when applied by inexperienced practitioners or in high-risk patient populations.
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.
Halanski et al. (Tue,) studied this question.