OCC Complications & Cast Management 2 — Questions and Answers
Question 1: A patient with a long leg cast reports a sudden onset of severe calf pain, warmth, and swelling three days post-application. The most likely complication is:
- Compartment syndrome
- Deep vein thrombosis (DVT) (Correct answer)
- Pressure sore
- Cast syndrome
Correct answer: Deep vein thrombosis (DVT)
DVT commonly presents days after immobilization with calf pain, warmth, and swelling due to venous stasis.
Question 2: When bivalving a cast to relieve pressure, the technician should cut along:
- The medial and lateral sides only
- The anterior surface only
- Both the medial and lateral sides, then spread the halves (Correct answer)
- The posterior surface only
Correct answer: Both the medial and lateral sides, then spread the halves
Bivalving involves cutting both sides of the cast and spreading the halves apart to decompress the limb effectively.
Question 3: A patient returns with a plaster cast that has become soft and dented. The most appropriate action is:
- Pad the soft area and reassess in one week
- Replace the cast immediately (Correct answer)
- Apply an elastic bandage over the cast
- Reinforce the cast with fiberglass tape
Correct answer: Replace the cast immediately
A soft or dented cast has lost its structural integrity and must be replaced to maintain proper fracture alignment.
Question 4: Which of the following best describes cast syndrome (Superior Mesenteric Artery syndrome)?
- Skin breakdown under a spica cast
- Vascular compression of the duodenum by the SMA causing nausea and vomiting (Correct answer)
- Compartment syndrome of the abdominal wall
- Pressure necrosis from a poorly fitting hip spica
Correct answer: Vascular compression of the duodenum by the SMA causing nausea and vomiting
Cast syndrome occurs when the SMA compresses the duodenum due to body position in a spica cast, causing nausea, vomiting, and abdominal distension.
Question 5: Which assessment finding would prompt immediate cast removal rather than a bivalve procedure?
- Mild itching under the cast
- Compartment pressures exceeding 30 mmHg with limb pallor and pulselessness (Correct answer)
- Minor swelling above the cast edge
- Slight skin discoloration at cast borders
Correct answer: Compartment pressures exceeding 30 mmHg with limb pallor and pulselessness
Compartment pressures above 30 mmHg with signs of vascular compromise require emergent fasciotomy after full cast removal.
Question 6: A patient in a thumb spica cast complains that the thumb tip is numb and the nail bed does not refill within 2 seconds. The FIRST action is:
- Reassure the patient and schedule follow-up in 48 hours
- Elevate the extremity and reassess in 30 minutes
- Immediately notify the supervising physician and prepare for cast modification or removal (Correct answer)
- Apply ice over the cast to reduce swelling
Correct answer: Immediately notify the supervising physician and prepare for cast modification or removal
Numbness with delayed capillary refill indicates neurovascular compromise requiring urgent physician notification and potential cast alteration.
Question 7: Thermal burns beneath a plaster cast most commonly result from:
- Patient skin sensitivity to calcium sulfate
- Exothermic reaction of plaster setting in too-hot water or with too many layers (Correct answer)
- Fiberglass off-gassing during curing
- Allergic reaction to the stockinette material
Correct answer: Exothermic reaction of plaster setting in too-hot water or with too many layers
Plaster generates heat as it sets; using water above 24°C or applying excessive layers dramatically increases burn risk.
OCC Complications & Cast Management 2
A patient with a long leg cast reports a sudden onset of severe calf pain, warmth, and swelling three days post-application.
The most likely complication is: