OTC Orthopaedic Technologist Certified Cast Complications and Removal 5 — Questions and Answers
Question 1: A patient with a long arm cast reports inability to extend the wrist and fingers. This finding is most consistent with compression of the:
- Median nerve at the wrist
- Ulnar nerve at the elbow
- Radial nerve at the lateral epicondyle (Correct answer)
- Brachial plexus at the shoulder
Correct answer: Radial nerve at the lateral epicondyle
Inability to extend the wrist and fingers (wrist drop) indicates radial nerve compression, which commonly occurs at the level of the elbow under a long arm cast.
Question 2: Cast itch (pruritus) should be managed by:
- Pouring water inside the cast to soothe the skin
- Using a knitting needle to scratch inside the cast
- Blowing cool air into the cast with a hair dryer on cool setting (Correct answer)
- Applying hydrocortisone cream through a cast window
Correct answer: Blowing cool air into the cast with a hair dryer on cool setting
Blowing cool air into the cast with a hair dryer on the cool (not hot) setting is a safe method to relieve itching without risking skin injury.
Question 3: When is it appropriate to cut a cast window?
- To routinely allow the skin to breathe every few days
- To inspect or treat a wound beneath the cast (Correct answer)
- To reduce swelling by allowing the limb to expand
- To permit routine neurovascular checks
Correct answer: To inspect or treat a wound beneath the cast
A cast window is cut to provide direct access to a wound for dressing changes or inspection without requiring full cast removal.
Question 4: After cutting a cast window, the removed piece should be:
- Discarded to allow maximum air circulation
- Replaced and secured to prevent 'window edema' (Correct answer)
- Left off permanently for wound monitoring
- Padded and used as a splint over the area
Correct answer: Replaced and secured to prevent 'window edema'
The cast window plug should be replaced and secured after each wound inspection to prevent localized swelling (window edema) in the exposed area.
Question 5: A patient presents 3 weeks after cast application with a documented fracture that appears malaligned on X-ray. The MOST appropriate initial step is:
- Apply a new cast immediately
- Notify the supervising physician (Correct answer)
- Attempt closed reduction and recast
- Discharge the patient with instructions to follow up in 2 weeks
Correct answer: Notify the supervising physician
Fracture malalignment discovered during follow-up requires physician notification to determine whether reduction or surgical intervention is needed.
Question 6: Which finding during neurovascular checks REQUIRES immediate physician notification?
- Mild swelling of the digits within the first 24 hours
- Absent radial pulse in a newly casted forearm (Correct answer)
- Patient-reported mild aching at the fracture site
- Slightly cool fingertips immediately after casting
Correct answer: Absent radial pulse in a newly casted forearm
An absent radial pulse indicates arterial compromise, which is a vascular emergency requiring immediate physician intervention.
Question 7: The PRIMARY reason for applying a well-molded cast rather than a poorly fitting one is to:
- Improve patient comfort and reduce anxiety
- Prevent fracture displacement and maintain reduction (Correct answer)
- Decrease the amount of padding required
- Allow earlier weight-bearing by the patient
Correct answer: Prevent fracture displacement and maintain reduction
A well-molded cast conforms to the limb's contours to maintain fracture reduction and prevent displacement during healing.
OTC Orthopaedic Technologist Certified Cast Complications and Removal 5
A patient with a long arm cast reports inability to extend the wrist and fingers.
This finding is most consistent with compression of the: