Casting the right decision

Several members of my family have suffered broken bones – a finger, an arm or a leg. Each time, the limb was put into a plaster cast, which is heavy and not washable. But I understand there are plastic casts that are lighter and washable. Why weren't my relatives offered such a cast? Is it available, but not offered because it costs more? Or are there medical reasons for not using such a cast? E.R., Netanya Dr. Nahum Kovalski, a medical technology consultant who previously was deputy director of TEREM, the private chain of urgent-care clinics, replies: A cast is one of the preferred methods for immobilizing the bone of a limb that has been injured by fracture, dislocation or break. Generally speaking, fiberglass casts are a legitimate option for a person who needs treatment for certain fractures and sprains. Fiberglass has the advantage, as noted, of being waterproof (if a special liner is used) and therefore less limiting during the time that the cast is in place. It is, however, significantly more expensive. A fiberglass cast is a lighter, synthetic alternative to the more traditional plaster version. It is created by padding the limb with cotton or waterproof padding material, followed by wrapping several layers of knitted fiberglass bandages impregnated with a water-soluble, quick-setting resin. It is lighter and more durable than plaster, so in many Western countries, fiberglass has quickly become the preferred type of casting with many patients and medical care providers. Casts made of this material require less maintenance than those made with plaster and are often used after the healing process has already begun. The fiberglass bandages on the outside of the cast are waterproof, but typically most of the padding materials inside the cast are not. Waterproof materials have been developed to replace this inside padding. This offers an option that would allow patients to bathe or shower, wash their hands, do chores and even swim while wearing a cast. The material is also reported to cut down on odor and itching by helping to wick moisture away from the skin under the cast. As with any type of cast, fiberglass has shortcomings. It sets quickly, so a less-experienced technician has less time to wrap the injured extremity properly. Many opponents of the use of fiberglass casts claim that synthetic materials leave less room for swelling. They are not always appropriate for more complex fractures where the bone is out of position. Plaster is more moldable than the knitted fiberglass and resin bandages, so a more comfortable fit can sometimes be achieved with plaster. Further, plaster is smoother and less likely to catch clothing or to rub skin raw. It is a classic example of the need to assess the cost-benefit of a treatment. Fiberglass casts would be lighter and more comfortable in many cases. But the cost of these casts has to be paid by someone. For many people, the additional cost is limiting. Cheap regular cast material is a viable option for everyone. I should note that there are definitely cases where a fiberglass cast would not be sufficiently strong to support certain more complex fractures. Also, it is sometimes possible to apply a cast splint, also referred to as a half-cast, which only covers half of the circumference of the fractured bone. Such cast splints are lighter and more comfortable. One should also remember that there are many cases when a cast does not have to be in place for six weeks or longer. Especially in children, a cast may only need to be in place for two weeks. Taking all this information into account, one can then make an informed decision about whether fiberglass casting is appropriate. Some medical services do offer patients the option to purchase the fiberglass casting material on-site. In other situations, the fiberglass material must be purchased at another location, adding to the difficulty of using it. At one point, TEREM did offer it, and very few people chose it. I haven't been at TEREM since June, so I don't know if it has been reinstituted. When all is said and done, old cheap casting material is a good option. Rx for Readers welcomes queries from readers about medical problems. Experts will answer those we find most interesting. Write Rx for Readers, The Jerusalem Post, POB 81, Jerusalem 91000, fax your question to Judy Siegel-Itzkovich at (02) 538-9527, or email it to jsiegel@jpost.com, giving your initials, age and place of residence.

Casting the right decision

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