A 23-year-old female sustained an undisplaced fracture of the midshaft of her left tibia. The fracture has been treated conservatively with a plaster cast. Two days later she has increasingly severe pain in her leg. Her toes are warm and pulses are present. What is the most important immediate action? A) Elevate the limb B) Refer to orthopaedics C) Remove the plaster cast D) Replace the cast with increased padding E) Re-x-ray the fracture site


C Remove pop Cast application soon after the injury need special attention One reason is a snug fitting cast expand inwards while setting and become tighter than planned Another thing in first 48 hrs inflammatory edema starts to set in Cast don't give much space to expand So the pop become tight First warning symptom is pain disproportionate to injury Indicate muscle ischemia Distal pulses are preserved Check capillary refill and stretch pain Pulse is the last to disappear in compartment syndrome There may be Paraestesia due to nerve ischemia First step remove all encircling bandages Give a well padded splint Elevate the limb Encourage active movements At this stage everything is reversible Once symptoms subside,pop can be reapplied with good padding Pop slab is preferable It can be converted to cast after 48 hrs or one week depending on type of fracture

Remove the plaster cast

C. Remove the plaster cast

C) Remove the cast

Refer to orthopeadic if under physiotherapy management . Or remove cast

Diseases Related to Discussion