COMPLICATION OF POP

SYSTEMIC COMPLICATIONS
DVT LEADING TO PE
IMMOBILISATION IN TRUNK PLASTERNAUSEA, ABDOMINAL CRAMPS, URINARY
RETENTION, ABDOMINAL DISTENSION

TIGHT CAST
-D/T PUT ON TIGHTLY OR BECOME TIGHT IF LIMB SWELLS
- DIFFUSE PAIN, OR SIGNS OF VASCULAR
COMPRESSION(PALE, LOSS OF POWER)
-NEED TO SPLIT CAST(OR BIVALVE) AND ELEVATE LIMB
-WHENEVER EXPECT SWELLING, CAST TO BE APPLIED OVER
THICK PADDING AND PLASTER SPLIT BEFORE IT SETS
-PAIN , COMPARTMENT SYNDROME, PERIPHERAL NERVE INJURY

PAIN
tissue damage at injury or reduction
swelling within the cast
muscle spasm
pressure on blood vessels or nerves
skin irritation or sores.

DELAYED COMPLICATIONS
PRESSURE SORE
LOSS OF POSITION
NERVE INJURY

PRESSURE SORES
-WELL FITTING CAST MAY PRESS UPON
SKIN OVER BONY PROMINENCE(PATELLA,
HEEL, ELBOW, OR HEAD OF ULNA)
-COMPLAINTS OF LOCALISED PAIN NEEDS
IMMEDIATE INSPECTION THROUGH A
WINDOW CAST

SIGNS
-BURNING, ITCHING, STABBING PAIN
-HEAT AND SWELLING OF DIGITS
-INCREASED WARMTN OVER A LOCALISED AREA OF
THE CAST
-VISIBLE PUS OR STAINING OF THE CAST

WHY?

Poor technique with adequate padding, or a ridge inside the cast, or failure to trim the
ends of the cast correctly.

Local cast breakdown with skin irritation due to poor care

Foreign bodies may easily slip between the cast and the skin. Children especially may
insert small toys, coins or beads while hairgrips may fall inside the cast.

Patients should be warned of these damages and also to care for the plaster edges since
wetting will cause plaster crumbs to be detached and fall inside the cast.

Scratching at minor irritation beneath the cast with metal implements or knitting needles
may cause trauma and infection. Such irritation should be reported and investigated early.

Plaster soakage leading to skin damage and infection

Cut edges of plaster following splinting or bivalving or window procedures may irritate the
skin especially if swelling occurs around the edge.

Grades of Sore
Sores are graded according to depth of the involvement.
Grade I-Redness of skin
Grade II-Involvement of Subcutaneous Tissue or cellulitis
Grade III- Involvement of Muscles
Grade IV- Bone Deep

LOSS OF POSITION
swelling occur with most fractures especially after reduction
the technician puts padding under the cast to protect the skin
This padding gets compressed
After 48 hours when the oedema is subsiding, the cast may be too loose to hold the
bone ends in position against undesirable muscle action.
Such displacement may be sudden and cause pain or gradual being first noticed on the
next x-ray
This complication may seriously delay sound healing and may produce permanent
deformity.

NERVE DAMAGE
Loss of power, tingling and numbness distal to the cast
The cause may be direct compression by bone ends or plaster
pressure, indirect compression of oedematous tissue or tourniquet
effect, or reduced blood flow.
Routine testing of power and sensation will detect any defect quickly.
Corrective action includes relieving cast pressure, supporting and
protecting paralyzed parts, and physiotherapy to help restore normal
function of muscle and joints.

SKIN ABRASION OR LACERATION

-COMPLICATION WHILE REMOVING
PLASTERS
-COMPLAINTS OF PINCHING OR NIPPING

IMPROPER APPLICATION
JOINT STIFFNESS
BLISTERS AND SORES
BREAKAGE

LOOSE CAST
-ONCE SWELLING SUBSIDES, NEED TO BE
REPLACED

ALLERGIC DERMATITIS

AVOID COMPLICATION
Application of the plaster cast should be done by a skilled person in proper manner
Strict elevation of the limb should be instructed.
Patient should report on pain that is not relieved, swelling, bluishness or pallor of
distal part.
Patient should be carefully examined in the follow up for probable complications of
plaster cast