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Special Conditions

Patients with a plaster cast

Plaster cast care:

  • Keep the plaster clean and dry
  • Exercise the fingers/toes of the affected limb regularly
  • Elevate the affected limb to prevent further swelling or discomfort
  • Exercise the joints above the plaster to prevent stiffening
  • Mild pain relievers may be necessary for the first few days. Please follow the dose recommended by the chemist
  • Plaster casts can vary and may take up to 72 hours to dry. you will be told by the nurse about your cast
  • If your leg is in plaster you will be told when you see the doctor if you are allowed to put any weight on the affected leg. Crutches/frames/sticks are available as required
  • Driving whilst you are in plaster is dangerous and your driving insurance may be invalid. Please contact your insurance company

Problems you may have:

  • The cast becomes tight, loose, cracked, soft or broken
  • The cast rubs or presses against the skin causing irritation
  • Leakage through the cast or it becomes too smelly
  • Your pain may become severe and constant
  • You may have severe and persistent itching under the cast
  • Your fingers or toes may become very swollen and numb, have pins and needles or change colour
  • You may get new calf pain with or without new leg swelling

If any of the above problems occur, please telephone the LGI plaster room on 0113 39 25717. ( Available Monday to Thursday 8.30 am to 5.45 pm and Friday 8.30 am to 1 pm).

Out of these hours please call 0113 39 23354.

Please do not:

  • Immerse your cast in water
  • Insert anything under your cast to scratch an itch
  • Trim or reshape your cast yourself
  • Use a hairdryer on the cast- let it dry naturally
  • Rest the plaster on a hard surface as it may dent or crack the cast

Patients with an external fixation device

Pin Site Care

Pin Sites are where wires or pins go through the skin before attaching to the bone. It is important to look after these carefully in order to prevent problems such as infection. Wherever possible the patient or family should take ownership and carry out the pin site care, with appropriate guidance and support. The methods our staff use and advise our patients to use are based on sound evidence and adhere to national guidelines.

After the Operation

The first pin site dressings are put on in the operating theatre at the end of the operation while the patient is still under anaesthetic. The first change of pin site dressing is carried out on the ward two days later. Normally this is the best opportunity for the patient and family to learn how to do it, taught by the ward nurse. 

Prior to being discharged home, the patient and family are given full instructions on pin site care, as well as given all the necessary equipment. Only if patients and families are incapable for whatever reason do we arrange for community nurses to carry out pin site care after discharge. Very occasionally if there are significant ongoing pin site problems will we arrange for the pin site care to be carried out by our outpatient staff.

Pin Site Changes

After the first pin site dressing change at two days, the basic principle of pin site care is to keep them covered at all times and change the dressing just once a week. Often this can be combined with a shower but the new dressing should not be placed on until the leg is totally dry. If there is a problem with oozing or infection, the dressing on the troublesome pin site should be changed twice a week, or every other day if required.

Cleaning Method and Equipment

Equipment Required:

  • One dressing pack
  • Sterile Gauze, non-sterile cotton wool buds or sponge sticks
  • Cleaning solution: 0.5% Hydrex/Saline/cool boiled water
  • Allevyn dressing and clean scissors
  • Sterile gloves

Method

  1. Wash your hands with soap and water. Put on gloves.
  2. Open the dressing pack and set out equipment using forceps.
  3. Pour the cleaning solution into the plastic tray.
  4. Cut the Allevyn sheet into 2cm squares with slit up the wire or pin.
  5. Pull plastic clips or bungs away from the skin up the wire or pin.
  6. Remove and discard old dressings in the yellow bag provided.
  7. Remove gloves, wash your hands, and put on a clean pair of gloves.
  8. Clean pin sites individually using sponge sticks/gauze/cotton wool buds soaked in the cleaning solution. Do not remove crusts.
  9. Ensure all sites are dry. If necessary, dry each site with a clean piece of gauze.
  10. Cover each pin site with a double layer of Allevyn (white side to the skin, pink side up).
  11. Push down clips or bungs with enough pressure to hold the dressing in place, but not too firmly.
  12. Dispose of the dressing pack, unused dressings and sharps, carefully.

Swelling, Pain Control and Problems with Wires

All patients suffer from swelling during the first few weeks, this is not painful. We encourage full weight-bearing and walking whenever possible which can lead to increased swelling, so we advise resting the leg on a stool or pillow after exercise.

If the swelling is associated with localised pain, redness, or discharge around a pin site area then this may represent an infection of the area. If the swelling causes the skin to touch the inside of the ring, then the patient should elevate the leg and inform our team as this can cause pressure on the skin.

Deep Vein Thrombosis is possible to develop but is extremely rare, particularly in children. We advise patients to contact or attend the frame clinic before attending the Emergency Department unless there are features suggestive of pulmonary embolus such as shortness of breath or chest pain.

Following discharge for the first few weeks, patients will need to take simple painkillers i.e. paracetamol and codeine to help with discomfort. Patients should avoid anti-inflammatory medicines such as ibuprofen and diclofenac as these can slow down bone healing. If the pain is getting worse or a new pain develops patients should inform the team.

Wires are tensioned and connected to the rings at the time of a patient’s operation. Although rare, post-operative these wires can disconnect from the ring or snap. If this does happen patients should not treat it as an emergency. We advise patients to stop putting weight through that leg and let the team know within a day or two. If this happens, we will reconnect or remove the wire in the clinics. In some cases, another minor procedure under general anaesthetic is to replace the wire.

Frame Removal

We are never able to predict exactly when the frame will be ready to be removed. The frame will be removed when the consultant is happy that it has been on for a reasonable amount of time for the case and is happy with the appearance of the leg from a detailed examination of x-rays or scans.

Patients may undergo a period of a few weeks when the frame is deliberately loosened or ‘dynamised’, this is done to test the leg so that no damage occurs once the frame is completely removed.

Nearly all children and some adults undergo a short procedure to remove the frame. This is done under general anaesthetic and after patients are free to walk on the leg without a cast but it is advisable to stay off sports and strenuous activity until after a review at six weeks.

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