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Leg Cylinder Cast

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Other Names

Illustration of the leg cylinder cast[1]
Final leg cylinder cast. Note the patient is able to put their sock on[2]
Distribution of the stockinette[3]
  • 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


Contraindications

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

Procedure

Equipment

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

See Also


References

  1. Image courtesy of https://www.childrenshospital.org/, "Types of Casts"
  2. Logerstedt, David, and Brian J. Sennett. "Case series utilizing drop-out casting for the treatment of knee joint extension motion loss following anterior cruciate ligament reconstruction." journal of orthopaedic & sports physical therapy 37.7 (2007): 404-411.
  3. Image courtesy of youtube.com, "Cylinder long leg cast using synthetic, combicast technique"
Created by:
John Kiel on 1 August 2023 12:18:13
Authors:
Last edited:
1 August 2023 12:50:06
Category: