Leg Cylinder Cast

Other Names

Illustration of the leg cylinder cast

Final leg cylinder cast. Note the patient is able to put their sock on

Distribution of the stockinette

• Leg Cylinder Cast
• Modified Leg Cylinder Cast
• Long Leg Cylinder Cast
• Stovepipe Cast

---

Background

• This page refers to the so-called long leg cylinder cast
  • It extends from groin to just above the malleoli
• This cast is distinct from the short leg cast, long leg cast
  • These casts extend down past the ankle to the foot

Advantage

• Adequately immobilizing the pathology around the knee without restricting the foot and ankle
  • This eliminates ankle stiffness, increases function and activities of daily living

Disadvantage

• It is prone to proximal-to-distal migration
  • This occurs due to lack of cast material stabilizing at the foot and ankle
  • Migrating cast increases likelihood of pressure sores at the malleoli

---

Indications

• Distal Femur Fractures
• Patella Fractures
• Proximal Tibia Fractures
• Knee Dislocation
• Soft tissue injuries around the knee

---

Contraindications

• Most acute fractures
• Open fractures
• Injuries with neurovascular compromise
• Fractures with active swelling

---

Procedure

Equipment

• See: Casting materials

Technique

• Patient Position
  • Knee should be slightly flexed around 10-25°
• Stockinette
  • Pull the stockinette over the whole leg extending 5-10 cm beyond the proximal and distal edges of the cast
• Cast Padding
  • Apply several layers of cast padding starting distal to proximal
  • Overlap about half the width of the padding avoiding protrusions, lumps and wrinkling
  • Apply extra cast padding above the ankle to help prevent slippage of the cast
  • Apply extra cast padding around the knee and thigh
• Cast Material
  • After immersing in water, apply the plaster (4-6 layers) or fiberglass (2-4 layers)
  • Each layer should overlap by about half the width
  • Roll the stockinette and cast padding over the rough edges of the cast material
  • Apply one additional layer over the stockinette and casting padding
• Confirm neurovascular status
• Maintain the knee at around 10-25° of flexion

---

Aftercare

• Typically non-weight bearing until re-evaluated
• Advise patient to keep cast or splint clean and dry
• Do not insert objects into splint/ cast
• Monitor for complications (worsening pain, paresthesia/ numbness, color changes)
• Seek further care if unable to control pain at home

---

Complications

• Acute Compartment syndrome
  • The ability to passively/actively extend fingers without discomfort indicates absence of muscle compartment compression
• Plaster burn/ thermal injury
• Pressure sores
• Nerve palsy
• Vascular compromise
• Splint dermatitis
• Permanent joint stiffness
• Skin infection
  • Cellulitis from underlying wound, pressure ulcers

---

See Also

• Casting Main
• Procedures Main

---