OCC Complications & Cast Management 3 — Questions and Answers
Question 1: A patient presents with foul odor and purulent drainage seeping through a 10-day-old cast. The priority intervention is:
- Irrigate through the cast with saline
- Apply topical antibiotic cream around the cast edges
- Remove the cast and assess for wound infection or skin breakdown (Correct answer)
- Reinforce the cast and prescribe oral antibiotics empirically
Correct answer: Remove the cast and assess for wound infection or skin breakdown
Purulent drainage and odor indicate infection or skin breakdown requiring immediate cast removal and wound assessment.
Question 2: Which technique reduces pressure necrosis risk at bony prominences during cast application?
- Applying the cast without padding to improve fit
- Using extra-tight bandaging to prevent migration
- Placing felt or foam padding over prominences before casting (Correct answer)
- Wetting the cast material before molding over prominences
Correct answer: Placing felt or foam padding over prominences before casting
Felt or foam padding over bony prominences distributes pressure and prevents focal necrosis beneath the cast.
Question 3: A patient with a short arm cast develops redness and blistering at the proximal cast edge. This is most consistent with:
- Cellulitis of the forearm
- Contact dermatitis from the casting material
- Mechanical pressure sore from a poorly trimmed cast edge (Correct answer)
- Early compartment syndrome
Correct answer: Mechanical pressure sore from a poorly trimmed cast edge
Blistering and redness localized to the cast edge indicate skin trauma from a rough or inadequately padded border.
Question 4: In a pediatric patient, which complication is uniquely associated with Salter-Harris fractures managed with casting?
- Growth plate arrest leading to limb length discrepancy (Correct answer)
- Higher rate of compartment syndrome than adults
- Faster cast degradation due to higher activity level
- Thermal burn susceptibility due to thinner pediatric skin
Correct answer: Growth plate arrest leading to limb length discrepancy
Damage to the physis (growth plate) can cause premature closure, resulting in angular deformity or limb length discrepancy.
Question 5: A patient reports severe burning pain under the cast starting 2 hours after application. The plaster was mixed with water at approximately 40°C. The most likely explanation is:
- Infection from improper aseptic technique
- Thermal burn from exothermic plaster setting reaction potentiated by hot water (Correct answer)
- Allergic contact dermatitis to plaster additives
- Compartment syndrome from the casting pressure
Correct answer: Thermal burn from exothermic plaster setting reaction potentiated by hot water
Hot water accelerates plaster setting, intensifying the exothermic reaction and producing temperatures capable of causing burns.
Question 6: Which of the following is the MOST reliable early indicator of compartment syndrome in a casted extremity?
- Skin discoloration visible above the cast
- Pain out of proportion to the injury, especially with passive stretch of muscles in the compartment (Correct answer)
- Pitting edema distal to the cast
- Cast warmth on external palpation
Correct answer: Pain out of proportion to the injury, especially with passive stretch of muscles in the compartment
Pain disproportionate to the injury and worsened by passive muscle stretch is the earliest and most reliable sign of compartment syndrome.
Question 7: After applying a fiberglass cast, the technician notices a focal hard ridge running lengthwise along the inner surface. The correct action is:
- Leave it; fiberglass ridges are normal and resolve as the cast cures
- Pad over the ridge externally with elastic bandage
- Remove and reapply the cast to eliminate the ridge before it causes a pressure ulcer (Correct answer)
- Apply heat to soften and smooth the ridge
Correct answer: Remove and reapply the cast to eliminate the ridge before it causes a pressure ulcer
An internal ridge creates a pressure point that will cause skin breakdown; the cast must be removed and reapplied correctly.
OCC Complications & Cast Management 3
A patient presents with foul odor and purulent drainage seeping through a 10-day-old cast.
The priority intervention is: