Casting and Immobilization

This entry describes casting and immobilization techniques for the injured athlete. Of the various types of casting and splinting materials used to immobilize the affected area, the two most commonly used today are plaster of paris and fiberglass. These materials come in both individual rolls (approximately 5 yards [4.57 meters] in length) and prefabricated layered rolls with padding that can be cut to length. These are available in various widths so that the affected part of the body is immobilized properly.

Splints are used immediately after the injury occurs or following surgery. Splinting is a way to immobilize the affected area and allow for swelling without compromising circulation. The splint, unlike a cast, is not circumferential and is usually placed on both the medial and the lateral side of the affected area and held in place with an elastic wrap. Many physicians prefer to use plaster of paris for splinting, owing to the greater moldability of plaster compared with fiberglass. This is true when one is trying to reduce or realign a fracture. Plaster allows a nice mold, relatively smooth against the skin, in whatever position is needed, whereas fiberglass tends to harden, with bumps and ridges that could cause irritation and other problems in the skin.

A cast is usually applied 7 to 10 days after the injury. This allows the swelling of the surrounding soft tissue to go down so that a solid cast can be applied for the remainder of the time needed for the injury to heal. If a cast is applied initially, it is a common practice to “bivalve” or split the cast with a cast saw to allow for swelling. The patient would then return for a final layer of material to make the cast solid.

In applying either a splint or a cast, the position of the affected area is extremely important. This is usually in an anatomic or neutral position, unless specified otherwise by the physician. Note: Sometimes the athlete is given approval by the doctor to return to sports while in the cast (usually a hand or arm cast). This could change the normal length or position of the cast. An example of this would be to apply a cast that would allow a hockey player to fit the cast or splint inside his or her glove and still be able to have a grip.