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Special Considerations in Casting and Bracing for These

Populations

Orthopaedic technologists must take into account anatomical, physiological, and healing
differences when applying casts and braces to pediatric and geriatric patients. The following
considerations ensure effective treatment while minimizing complications.

1. Pediatric Considerations

Pediatric patients require specialized approaches in casting and bracing due to their rapid
growth and developing musculoskeletal system.

• Growth Plate Protection: Since pediatric bones are still growing, improperly applied casts can
compress the growth plate, leading to growth disturbances or deformities.
• Flexibility of Pediatric Bones: Pediatric bones are more pliable, allowing for faster healing but
also requiring lightweight and flexible casting materials to avoid excessive restriction.
• Use of Waterproof and Breathable Materials: Children are more active and prone to getting
casts wet. Modern waterproof fiberglass casting materials help maintain hygiene and comfort.
• Parental Education and Compliance: Parents must be thoroughly instructed on monitoring
for complications such as:
o Swelling and circulation issues (check for cool fingers/toes, numbness, excessive pain).
o Skin irritation or pressure sores from prolonged cast wear.
o Activity limitations to prevent re-injury.
• Bracing for Growth Adjustments: Pediatric braces, such as scoliosis braces or clubfoot
orthoses, must accommodate ongoing growth and periodic adjustments to maintain
effectiveness.
• Growth Plate Protection: Casts must allow for continued growth without causing compression.
• Flexibility of Pediatric Bones: Lighter, more flexible casting materials are often preferred.
• Parental Education: Teaching caregivers how to monitor for circulation issues and cast
integrity.

2. Geriatric Considerations

Geriatric patients present unique challenges due to decreased bone density, skin fragility, and
reduced mobility, necessitating careful selection of casting and bracing materials.

• Skin Fragility and Pressure Ulcers: Older adults have thinner skin, increasing the risk of
pressure sores and irritation under a cast or brace. Strategies to mitigate this include:
o Using padded, soft-lining materials inside casts.
o Frequent skin inspections and adjustments to relieve pressure points.
• Weight-Bearing Limitations: Many elderly patients have osteoporosis or arthritis, affecting
their ability to bear weight. Orthopaedic technologists should:
o Use lightweight materials to reduce the burden on weakened limbs.
o Provide custom orthoses to redistribute pressure and improve balance.
• Custom Bracing for Osteoporotic Patients: Patients with osteoporosis are at high risk for
vertebral compression fractures. TLSO (thoracolumbosacral orthosis) braces can help
stabilize the spine and reduce pain.