Long Leg Cast

Other Names

Illustration of long leg cast

Stockinette distribution for the long leg cast

final product of the long leg cast

• Long Leg Cast
• Long leg casting

---

Background

• 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

---

Indications

• Knee
  • Some nondisplaced Supracondylar Femur Fractures
• Leg
  • Tibial Shaft Fracture
• Ankle
  • Some Distal Tibia Fractures

---

Contraindications

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

---

Description

Equipment

• See: Casting materials

Technique

• 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

---

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

---