OTC Orthopaedic Technologist Certified Cast Complications and Removal 3 — Questions and Answers
Question 1: Compartment syndrome in a casted limb is BEST confirmed by:
- Observation of skin color alone
- Measurement of compartment pressure (Correct answer)
- Patient's verbal pain rating
- Radiographic evaluation
Correct answer: Measurement of compartment pressure
Definitive diagnosis of compartment syndrome requires direct measurement of intracompartmental pressure, typically using a pressure monitor.
Question 2: A patient returns with a cast applied 5 days ago and the cast is now loose and poorly fitting. The most likely reason is:
- Incorrect casting technique
- Normal bone healing progression
- Reduction in swelling since application (Correct answer)
- Material fatigue of the cast
Correct answer: Reduction in swelling since application
Post-injury edema typically resolves within days, causing the cast to become loose as the limb volume decreases.
Question 3: The 5 P's used to assess neurovascular status in a casted limb include pain, pallor, pulselessness, paresthesia, and:
- Pressure
- Paralysis (Correct answer)
- Perspiration
- Pigmentation
Correct answer: Paralysis
The classic 5 P's of neurovascular compromise are pain, pallor, pulselessness, paresthesia, and paralysis (inability to move).
Question 4: Which instruction is MOST important to give a patient regarding cast hygiene?
- Clean inside the cast with a damp cloth daily
- Keep the cast dry at all times unless it is waterproof (Correct answer)
- Use talcum powder freely to relieve itching
- Wrap the cast in plastic for showering without concern
Correct answer: Keep the cast dry at all times unless it is waterproof
Keeping a conventional plaster or fiberglass cast dry prevents cast softening, skin maceration, and infection.
Question 5: A patient with a thumb spica cast develops numbness and tingling in the thumb and index finger. This finding suggests compression of the:
- Ulnar nerve
- Radial nerve
- Median nerve (Correct answer)
- Musculocutaneous nerve
Correct answer: Median nerve
The median nerve supplies sensation to the thumb, index, and middle fingers; compression under a thumb spica cast produces these symptoms.
Question 6: When splitting a cast for bivalving, the second cut is placed:
- Parallel and adjacent to the first cut
- On the medial side regardless of cast location
- 180 degrees opposite the first cut (Correct answer)
- At a 45-degree angle to the first cut
Correct answer: 180 degrees opposite the first cut
Bivalving requires two cuts placed on opposite sides of the cast (180° apart) to create two equal halves that can spread open.
Question 7: Which of the following best describes 'cast disease' (disuse atrophy)?
- Infection of skin beneath the cast
- Muscle wasting and joint stiffness from immobilization (Correct answer)
- Allergic reaction to casting material
- Bone loss due to fracture malunion
Correct answer: Muscle wasting and joint stiffness from immobilization
Cast disease refers to muscle atrophy, joint stiffness, and osteoporosis resulting from prolonged immobilization of the limb.
OTC Orthopaedic Technologist Certified Cast Complications and Removal 3
Compartment syndrome in a casted limb is BEST confirmed by: