Fracture Casting & Splinting

What Is Fracture Casting and Splinting?

Casting and splinting are time-tested methods for treating bone fractures without surgery. By immobilizing the injured bone in proper alignment, these techniques allow the body’s natural healing process to mend the fracture. For many patients, casting and splinting are all that is needed for a complete recovery, making them a cornerstone of our non-surgical-first treatment philosophy.

At our San Diego practice, we use casting and splinting to treat a wide range of fractures in the wrist, forearm, hand, foot, ankle, and lower leg. These methods are effective for stable fractures where the bone fragments are well-aligned or can be aligned without an incision.

When Is Casting or Splinting Used?

Your orthopedic surgeon may recommend a cast or splint in the following situations:

• Stable fractures where the bone is cracked but the fragments remain in good position
• After closed reduction when displaced bone fragments have been manually realigned and need to be held in place during healing
• Growth plate fractures in children where maintaining alignment is essential for normal bone development
• Stress fractures that require offloading and rest to heal
• Post-operative support in some cases, a cast or splint is used temporarily after surgical fixation to provide additional protection

The Procedure

Evaluation and Reduction

Before applying a cast, your doctor will review your X-rays to assess the fracture pattern and alignment. If the bone fragments are displaced, a procedure called closed reduction may be performed. During closed reduction, your doctor applies gentle, controlled pressure to guide the bone fragments back into proper position. Local anesthesia or a nerve block is administered beforehand to minimize discomfort.

Follow-up X-rays are taken immediately after reduction to confirm the bones are properly aligned before the cast is applied.

Splinting vs. Casting

• Splints are partial immobilization devices, typically made of plaster or fiberglass, that are held in place with an elastic bandage. Because they do not wrap completely around the limb, splints accommodate swelling and are often used as the initial treatment in the first few days after injury. They may also serve as the definitive treatment for certain stable fractures.

• Casts are rigid shells that encircle the limb completely, providing more secure immobilization. A cast is typically applied once swelling has subsided, often replacing an initial splint. Casts are made from plaster or fiberglass, with fiberglass being lighter and more durable.

Types of Casts

The type of cast depends on the location and nature of your fracture:

• Short arm cast — extends from below the elbow to the hand; used for wrist and hand fractures
• Long arm cast — extends from the upper arm to the hand; used for forearm fractures and some elbow injuries
• Short leg cast — extends from below the knee to the foot; used for ankle and foot fractures
• Long leg cast — extends from the upper thigh to the foot; used for certain lower leg and knee fractures
• Walking boot — a removable boot used for stable foot and ankle fractures that allows limited weight bearing

What to Expect

The casting process itself takes about 20 to 30 minutes. Your doctor or a trained technician will apply a protective cotton liner, followed by layers of plaster or fiberglass material that are moistened and molded around your limb. The material hardens within minutes, though full curing may take 24 to 48 hours for plaster casts.

You may feel warmth as the cast material sets. Once the cast is in place, your doctor will review instructions for care and warning signs to watch for.

Cast Care Instructions

Proper care of your cast is essential for a smooth recovery:

• Keep it dry — moisture weakens plaster and can cause skin irritation under the cast; cover your cast with a plastic bag when showering
• Do not insert objects — never stick items into the cast to scratch an itch, as this can damage the skin and lead to infection
• Elevate the limb — keeping the injured area elevated above your heart helps reduce swelling, especially in the first few days
• Watch for warning signs — contact your doctor immediately if you experience increasing pain, numbness, tingling, a change in skin color in your fingers or toes, or a foul odor from the cast
• Keep moving — gently exercise your uninjured joints (such as your fingers or shoulder if you have a wrist cast) to prevent stiffness

Follow-Up

Regular follow-up appointments are a critical part of fracture care. We typically schedule visits at one to two week intervals to:

• Take X-rays to monitor bone healing and ensure the fracture remains aligned
• Assess your pain and comfort level
• Check the condition of the cast and replace it if necessary
• Determine when the cast can be safely removed

Once your fracture has healed sufficiently, the cast is removed with a small oscillating saw that vibrates through the cast material without cutting the skin. Your doctor will then evaluate your range of motion and strength and, in most cases, recommend physical therapy to help you regain full function.

If you have sustained a fracture and want to learn whether casting or splinting is the right treatment for you, contact our San Diego office to schedule an evaluation. Our orthopedic team will assess your injury and develop a personalized treatment plan focused on getting you back to your normal activities.