Compartment syndrome

Red flags for compartment syndrome are pain out of proportion with the injury, and pain on passive stretch of the digits. Later signs include pallor, paresthesia and pulselessness; appearance of these signs should not be waited for! If compartment syndrome is suspected, the cast and any dressings should be removed.

Pressure points/skin breakdown

A localized burning point under the cast under the cast suggests that excessive pressure is being exerted by the cast. If the patient complains of numbness or motor dysfunction, the cast may be putting pressure on an underlying nerve. This happens most commonly with the peroneal and radial nerves.

Skin irritation

Skin irritation may occur at the cast edges if not properly padded, especially with fiberglass casts.

Loss of reduction

As swelling subsides, the cast will become looser, and fracture reduction may be lost. This can be avoided by following up with the patient 7-10 days after cast application, to ensure the cast still fits properly.