Page 195 - ASOP ROT Study Guide

General indications that a cast may be too tight are complaints of tightness, swelling distal to the
cast, duskiness of the skin, loss of peripheral pulses, tingling and loss of sensation. In extreme
cases there may be a compartment syndrome in association with cast tightness. If these features
are present then the cast must be split or removed.

3.5.2 Protection of particular areas
The following areas require particular attention because of anatomically vulnerable structures:
♦ The head of the fibula - this is an area of the fibula just below the skin and round which the
common peroneal nerve winds.
♦ The malleoli - these structures are only protected by skin and the area has a poor blood
supply, often made worse by venous congestion in the elderly, (see Figure 8)
♦ The distal end of ulna - again this is just under the skin and is very prominent, particularly in
those patients suffering from rheumatoid arthritis.
♦ Other superficial bony points include the olecranon, the acromion and the crest of the pelvis.
All these areas must be padded carefully to avoid excess pressure which may lead to skin
breakdown.

FIGURE 8. AREAS WHICH REQUIRE EXTRA PADDING.