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Why casts are changed?
Why casts are changed?


A friend of mine at U Maryland, Dr. Josh Abzug, was involved with an interesting study that was published last year. He and his colleagues looked at all of the reasons that patients returned to their doctors because they needed their casts changed earlier than was planned.

Casts need to be changed regularly. This is part of the package in dealing with this effective, but cumbersome, treatment option. All sorts of life mishaps can thwart our efforts to use casts.


What Dr. Abzug and colleagues found, which is something which I have personally seen in our practice as well, is that most kids come back for early (unscheduled) cast changes because of water. Water from a pool, pond, rain or sibling mishaps, mixed with cast material can produce an unpleasant, hard to dry, soggy mess. More important, it can weaken the cast so that it is no longer effective.

In their study they found that about 5% of patients returned because their cast broke or was rendered useless.

So, what were their recommendations? Well, they came up with a list of recommendations that we also use.


  • Don’t put your cast in water
  • Avoid unsupervised lay near water (pool, fire hydrant, pond, etc)
  • Don’t wrap your child’s cast with plastic and let him or her play in the water (these do not provide good protection from water)
  • Use a commercial cast bag if possible
  • Don’t put anything in your cast!
  • Don’t try to remove your own cast.


Is there any other way to avoid water destroying a cast yet still get a cast wet?


The use of waterproof cast padding with fiberglass cast material (not plaster cast material) may eliminate most of the unscheduled visits. I am not a big fan of waterproof cast lining, but will occasionally use it for fractures that are very stable.

I do, however, like using protective splints, many of which can be made water resistant for wet   bsummer activities.

But, when in doubt, keep it dry!

Incidence and Etiology of Unplanned Cast Changes for Fractures in the Pediatric Population

J Pediatr Orthop. 2014 Sep;34(6):643-6. Incidence and etiology of unplanned cast changes for fractures in the pediatric population. DiPaola MJ1, Abzug JM, Pizzutillo PD, Herman MJ.

This post does not provide medical advice. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on any web site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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