Casting: Pearls and pitfalls learned while caring for children’s fractures

Figure 1 Well-molded cast. A: Pre-reduction X-rays of pediatric forearm demonstrating a completely displaced distal both bone forearm fracture. Immediate post-reduction X-rays; B: Immediate post-reduction X-rays demonstrating adequate reduction with a flexion mold to prevent fracture from dorsal displacement; C: Three-months follow-up X-rays demonstrating completely healed fracture with near-anatomic alignment.

Figure 2 Cast index. A: Initial X-rays of a pediatric forearm fracture with angulation; B: Immediate post-reduction X-rays demonstrating an appropriate cast application based on the cast index (< 0.8). Cast index = Saggital width/coronal width = 41.4 mm/54.4 mm = 0.76.

Figure 3 Loose cast. Pediatric cast that was applied too loosely. The physician’s hand (right) was able to pull the cast off the child easily.

Figure 4 Cast spacers. Cast spacers with four different size settings (3, 6, 9 and 12 mm).

Figure 5 Saw Stop© protective strip (A and B). This protective strip is placed on top of the webril layer before applying the fiberglass cast roll. The strip provides a durable protective layer for the cast saw to cut over.