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Long Leg Cast

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Other Names

Illustration of long leg cast[1]
Stockinette distribution for the long leg cast[2]
final product of the long leg cast[3]
  • Long Leg Cast
  • Long leg casting


  • This page refers to the long leg cast
    • This cast extends from the upper thigh down to the metatarsals
    • It immobilizes both the knee and ankle joint



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




  • Patient Position
    • Patient should be supine
    • With assistant(s) the hip and knee are flexed to about 60°
  • Stockinette
    • Stockinette should be long, extending up into the groin and past the toes
    • Typically 5-10 cm longer than anticipated length of cast
  • Cast Padding
    • Proximal edge: greater trochanter and just below the groin
    • Distal edge: extends to distal edge of metatarsals
    • 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 around bony prominences and the heel
  • 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
  • Mold the cast at the area of injury to prevent further displacement of the fracture
    • Hold in position until cast material hardens


  • 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


  • 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


  1. https://surgeryreference.aofoundation.org/
  2. Image courtesy of uptodate.com, "Tibial Shaft Fractures"
  3. Image courtesy of https://a1props.com/, "Cast Kit"
Created by:
John Kiel on 10 June 2021 23:39:07
Last edited:
1 August 2023 13:56:27