Cast/Splint Care & Crutch Use

Instructions

Fractures are often initially treated with a sling, immobilizer, splint, cast, or brace depending on the location.

At first it is very important to control pain and swelling. As much as possible the injured extremity should be elevated above the heart level. This will reduce swelling and pain and can be done by using pillows or cushions at home.

It is important to keep casts and splints dry as once become wet they will cause skin issues and will smell.

It is very important to keep in mind the following signs. If you notice them you should report to a local emergency room immediately:

• Pain is increasing and nothing seems to help (elevation, ice, rest, medication).
• Swelling is getting worse and there is loss of color or feeling in the fingers.
• Reactions to medications (such as itching, rashes, swelling of the face, difficulty breathing or swallowing).The cast or other form of immobilization is broken or not working and the fracture is not stabilized.

Pain medication is appropriate since fractures can be quite painful. Medication should be taken every 3-4 hours as needed. Pain management is accomplished by taking it easy, elevating the injured extremity and taking pain medication as needed. Since medication only lasts for about 4 hours, it is important to take a pill around that time if the pain begins to return and seems to be increasing. Adjustments can be made to find the correct type of pill and dose for each patient. Almost all of the pain medications used today can have adverse effects including nausea, dizziness, constipation or allergic reactions. Care should be taken if these symptoms are severe and alternative medications should be tried.

At your initial visits the fracture will be evaluated with x-rays. The integrity of the immobilization will be evaluated and a treatment plan will be prescribed. It is important to adhere to this plan as fractures may not heal, may be delayed, or may heal in a poor position without proper care.

Once the fracture has healed sufficiently the cast/splint/sling/boot can be removed and therapy begun. Return to work or school will depend upon the nature of your injury and the nature of your work. This should be discussed on an individual basis. Driving is not recommended while you are impaired. You should not drive while taking narcotic pain pills. We recommend driving only when you can use both hands and legs to safely operate the controls of the vehicle.

Crutches fit properly when the top of the crutch measures approximately three fingers below the armpit while standing straight up.

Please note that proper fitting crutches should not place any weight in the armpit while walking as this may cause damage to the axillary nerve. Instead weight should be applied through the hands and chest wall (ribs). To help with this keep elbows bent at 30 degrees as this allows for efficient use of arm muscles.

The following are specific walking instructions:

• Non-Weight Bearing: If the doctor’s instructions indicate non-weight bearing on the affected leg, when walking, set the crutches about one foot ahead and swing the affected leg through while stepping on the unaffected leg. Do not set the affected leg down on the ground.
• Toe-Touch Weight Bearing: If the doctor’s instructions indicate toe touch weight bearing, set your leg down on the ground and apply minimal pressure to the affected leg. It is okay to step with the affected leg at the same time that setting the crutches down, applying most of the weight through the hands to the crutches.
• Partial Weight Bearing: If the doctor’s instructions indicate partial weight bearing or weight bearing as tolerated with the crutches, it is okay to step on the affected leg, but not with full weight. When walking, step on the affected leg at the same time as setting down the crutches, putting equal pressure on hands and legs.

Walker’s may be easier to use if crutches cause a feeling of uneasiness or unsteady balance.