COMMON CAST TYPES
Upper Extremity Casts
Upper Extremity Casts
are those which encase the arm, wrist, and/or hand. A long arm cast encases the arm from the hand to about 2 inches below
the arm pit, leaving the fingers and thumbs free. A short arm cast, in contrast, stops just below the elbow. Both varieties
may, depending on the injury and the doctor's decision, include one or more fingers or the thumb, in which case it is
called a finger spica or thumb spica cast.
Lower Extremity Casts
Lower Extremity Casts are classified similarly, with a cast encasing both
the foot and the leg to the hip being called a long leg cast, while one covering only the foot and the lower leg is called
a short leg cast. A walking heel may be applied, or a canvas or leather cast shoe provided to the patient who is expected
to walk on the immobilized limb during convalescence (referred to as being weight bearing). Where the patient is not to walk
on the injured limb, crutches or a wheelchair may be provided. The sole of a leg cast may also be extended to the tip of the
toes, if providing a toe plate. This addition may be made to offer support to and stabilize the metatarsals and to protect
the toes from additional trauma. This is a common treatment for a broken foot. Toe plates are infrequently used in the USA,
and are more common in continental Europe.
In some cases, a cast may include the upper and lower arm and the elbow,
but leaves the wrist and hand free, or the upper and lower leg and the knee, leaving the foot and ankle free. Such a cast
may be called a cylinder cast, or may simply be called a long arm or long leg cast.
Body casts, which
cover the trunk of the body, and in some cases the neck up to or including the head (see Minerva Cast, below) or one or more
limbs, are rarely used today, and are most commonly used in the cases of small children, which cannot be trusted to comply
with a brace, or in cases of radical surgery to repair an injury or other defect. A body cast which encases the trunk (with
"straps" over the shoulders), is usually referred to as a body jacket.
A cast which includes
the trunk of the body and one or more limbs is called a spica cast, just as a cast which includes the "trunk" of
the arm and one or more fingers or the thumb is. For example, a shoulder spica includes the trunk of the body and one arm,
usually to the wrist or hand. Shoulder spicas are almost never seen today, having been replaced with specialized splints and
slings which allow early mobility of the injury so as to avoid joint stiffness after healing.
A hip spica includes the trunk
of the body and one or more legs. A hip spica which covers only one leg to the ankle or foot may be referred to as a single
hip spica, while one which covers both legs is called a double hip spica. A one-and-a-half hip spica encases one leg to the
ankle or foot and the other to just above the knee. The extent to which the hip spica covers the trunk depends greatly on
the injury and the surgeon; the spica may extend only to the navel, allowing mobility of the spine and the possibility of
walking with the aid of crutches, or may extend to the rib cage or even to the armpits in some rare cases. Hip spicas were
formerly common in reducing femoral fractures, but today are rarely used except for congenital hip dislocations, and then
mostly while the child is still an infant.
In some cases, a hip spica may only extend down one or more legs to above the
knee. Such casts, called pantaloon casts, are occasionally seen to immobilize an injured lumbar spine or pelvis, in which
case the trunk portion of the cast usually extends to the armpits.
Other body casts which were used
in decades past to protect an injured spine or as part of the treatment for a spinal deformity (see scoliosis) which are rarely
seen today include the Minerva cast and Risser cast. The Minerva cast includes the trunk of the body (sometimes extending
down only so far as the rib cage) as well as the patient's head, with openings provided for the patient's face, ears,
and usually the top of the head and hair. The Risser cast was similar, extending from the patient's hips to the neck and
sometimes including part of the head. Both of these casts could, with care and the doctor's permission, be walked in during
convalescence. However, in some cases the Risser cast would extend into one or more pantaloons, in which case mobility was
far more restricted.
Aside from the above common forms, body casts could come in nearly any size and configuration. For
example, from the 1910s to the 1970s, use of a turnbuckle cast, which used metal turnbuckles to twist two halves of the cast
so as to forcibly straighten the spine before surgery, was common. The turnbuckle cast had no single configuration, and could
be as small as a body jacket split in half, or could include the head, one or both legs to the knees or feet, and/or one arm
to the elbow or wrist depending on the choice of the doctor.
Despite the large size and extreme immobilization some casts, particularly
those used in or before the 1970s, the popular term full body cast is something of a misnomer. The popular and media-driven
conception of a massive cast encasing all four limbs, the trunk, and the head - sometimes leaving only small slits for the
eyes, nose, and mouth - is a true rarity in recorded medical history, and this type of large scale cast appears more commonly
in throughout various Hollywood movies and on television shows. The term body cast (or full body cast) is sometimes casually
used by laymen to describe any of a number of body and or spica casts, from a simple body jacket to a more extensive hip spica.