29345 Application of long leg cast (thigh to toes)

Name of the Procedure:

Application of Long Leg Cast
Common name(s): Long leg cast
Technical term: Application of a cylindrical cast extending from the thigh to the toes.

Summary

In this procedure, a cast is applied starting from the upper thigh down to the toes to immobilize the leg. This ensures proper healing by restricting movement.

Purpose

The long leg cast is used to stabilize fractures, severe sprains, or soft tissue injuries to the knee, lower leg, or ankle. The goal is to promote healing by keeping the leg in a fixed position.

Indications

• Fractures of the tibia or fibula
• Severe ligament or tendon injuries
• Post-operative support for leg surgeries
• Certain knee injuries that require prolonged immobilization

Preparation

• Patients typically do not need to fast.
• Discuss current medications with your doctor; some adjustments may be necessary.
• Diagnostic imaging (e.g., X-rays, MRI) to assess the injury.
• Skin should be clean and free of lotions or creams.

Procedure Description

1. Initial Assessment and Setup: The patient is positioned comfortably, typically lying down.
2. Padding and Stockinette Application: A soft cotton or synthetic padding and a stockinette are applied to protect the skin.
3. Casting Material Application: Plaster or fiberglass casting material is soaked in water and wrapped around the leg from the upper thigh to the toes.
4. Molding and Setting: The cast is molded to the shape of the leg and allowed to set. Proper alignment is ensured during this stage.
5. Final Adjustments: Once the cast hardens, any sharp edges are smoothed out.

Tools and Equipment:

• Stockinette
• Padding
• Plaster or fiberglass casting material
• Water for activation
• Scissors and cast saw for adjustments

Anesthesia:

• Generally, no anesthesia is required for applying a cast.

Duration

The procedure typically takes about 30 to 45 minutes.

Setting

The procedure is usually performed in a hospital, outpatient clinic, or orthopedic specialist's office.

Personnel

• Orthopedic surgeon or trained medical professional applying the cast
• Nurses or medical assistants for support

Risks and Complications

• Skin irritation or sores
• Swelling or loss of circulation if the cast is too tight
• Muscle atrophy from prolonged immobilization
• Rare: Deep vein thrombosis (DVT) or infection

Benefits

• Provides immobilization for proper healing
• Stabilizes fractures and prevents further injury
• Pain relief when the leg is immobilized

Recovery

• Follow post-procedure instructions for care, including keeping the cast dry.
• Elevate the leg to reduce swelling.
• Use crutches or a walker as recommended.
• Follow-up appointments for cast adjustments or removal, typically after 4-8 weeks.
• Physical therapy may be needed post-cast removal to regain strength and mobility.

Alternatives

• Splints or braces for less severe injuries
• Functional bracing allowing some movement
• Surgical intervention in complex fractures

Pros and Cons of Alternatives:

• Splints/Braces: Less restrictive but may not offer the same level of immobilization.
• Surgery: May provide quicker stabilization but has its own risks and complexities.

Patient Experience

• During the procedure, the patient will feel wet and cool sensations as the cast material hardens.
• Some initial discomfort as the cast sets, but this often subsides.
• Post-procedure: Expect possible itching, mild discomfort, and the need to adapt to limited mobility.
• Pain management with over-the-counter analgesics if needed.