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Short Leg Cast

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Other Names

Illustration of the short leg cast[1]
The short leg cast final product[2]
The short leg walking cast[2]
  • Short Leg Cast
  • Short Leg Walking Casts
  • Short leg cast with toe plate extension

Background

  • This page refers to the short leg cast
  • Toe Plate Extension
    • Can be added for distal metatarsal, phalangeal fractures

Indications


Contraindications

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

Procedure

Equipment

Technique

  • Patient positioning
    • Patient should be positioned so that the proceduralist has access to the affected leg
    • Most commonly the patient is seated on a treatment table with the leg hanging
    • Alternatively, the patient can lay prone with the knee flexed
    • The ankle should be immobilized in a neutral position at 90°
  • Stockinette
    • Should extend about 5-10 cm proximal to fibular head and and additional 5-10 cm distal to the metatarsal heads
  • 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 padding over the calcaneus, fibular head (if covered), and both malleoli
  • 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 ankle in a neutral position until the cast material hardens

Toe Plate Extension

  • Casting technique is essentially the same
  • Extend the casting material beyond the distal toes on the plantar surface
    • This prohibits plantarflexion and limits dorsiflexion

Pearls and Pitfalls

  • Weight bearing recommendations are made by the type, stability of the injury

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://surgeryreference.aofoundation.org/, "Short Leg Cast"
  2. 2.0 2.1 Bica, David, Ryan A. Sprouse, and Joseph Armen. "Diagnosis and management of common foot fractures." American family physician 93.3 (2016): 183-191.
Created by:
John Kiel on 31 July 2023 15:07:17
Authors:
Last edited:
1 August 2023 12:40:47
Category: