Cast Care Instructions and Precautions.
Casts are not risk free.
Proper care and precautions will reduce the risks.We do not use "waterproof"
casts. The cast must be kept dry. A wet cast is an emergency when it is
wet on the inside. It must be removed within two hours in order to avoid
skin complications. To complicate matters, a fracture may fall into an
unacceptable position while changing the cast requiring a return to the
operating room. A sponge bath is the easiest way to keep the cast dry
while bathing. Bathing in the bathtub with the extremity elevated over the
side is the second best method. Avoid showers, rain, and falling into
pools. Plastic bags may provide a false sense of security. They do not
keep a cast dry during submersion, in a shower or rainstorm. They may help
some, however over reliance on plastic bags are the single most common
reason casts get wet.
Most casts cause itching. The best treatment is anti-itch medications
such as Benadryl®. Non-medicinal means include tapping on the
cast, application of ice. Avoid sliding the cast up and down or placing
objects with which to scratch inside the cast. This may cause movement of
the fracture into a mal-position or serious skin infections hidden by the
cast. Do not put sand or anti-itch powders inside the cast.
Children by their very nature may store objects such as coins, pretzels,
cheese inside the cast for later. This is a frequent cause for skin
complications. Children are at risk for getting the cast wet, and pulling
the padding from under the cast. If they succeed, we should see them on
follow-up sooner to correct their cast problems.
Some casts may cause mild swelling in the fingers or toes. Mild swelling
that is not on the increase is typically not a problem. You should
follow-up as soon as possible or consider going the emergency room if the
swelling is on the increase, the cast causes tingling or increased pain.
Keep the cast elevated, and apply cold packs to the cast in order to prevent
swelling. Gentle gripping exercises will help reduce or prevent finger
swelling.
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Pin Care
Instructions.
Some fracture surgeries involve placing pins through
the skin and into bone. These include Percutaneous pins and external
fixator pins used commonly for wrist and leg fractures. The pin sites must
be kept clean, dry, and covered with a dressing. The first dressing change
takes place in the office or at bedside one to three days after surgery.
You may then do daily dressing changes at home. Along with the dressing
changes, the pin sites must be cleaned every day. Use sterile cotton swabs
wetted with hydrogen peroxide to remove any crusts or debris from the pin
site. The skin should not be adherent to the pin. Increase the frequency
of pin care to twice per day if increased debris accumulation warrants.
Check the pin sites for increasing watery drainage or pus, redness, pain,
tenderness or swelling. This could signify infection which requires an
earlier follow-up appointment.
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Wound Care Instructions.
Surgical wounds typically heal within two to three
weeks. Wound infections may appear for up to four weeks after surgery.
Change the dressing every day. Clean the skin area covered by the dressing
with hydrogen peroxide with each dressing change. Stitches or staples come
out on the 14th day after hip and knee replacement, and 10-14 days after
other surgeries. Watch the wound for redness, swelling tenderness or
increasing pain. This is not a problem that can be managed appropriately
over the telephone. Should these occur, you must make a same-day follow-up
appointment. Visit the emergency room if the office is not open or if you
have flu-like symptoms like fever, chills, night sweats, fatigue and body
aches.
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Cortisone Injections.
The common office injections using cortisone
are used to treat trigger finger, some shoulder problems, hip bursitis,
trigger points in the back, and osteoarthritis of the hand, shoulder and
knee. We order injections in the hip joint or epidural steroid injections
in the spine on consultation when needed after evaluation in the office.
These are more invasive, may require fluoroscopic or CT guidance, and are
performed by interventional radiologists or anesthesiologists.
Cortisone injections are made up from a mixture of
low-dose steroid and numbing medicine like your dentist uses. Frequently,
the numbing effect will relieve the pain immediately, but wear off 3 to 6
hours after the injection. Sometimes the steroid will cause an aching or
burning sensation lasting 24-48 hours. This is normal and expected.
Application of ice and resting will help relieve these symptoms. If
you are diabetic, you should monitor your blood sugar level more closely
after a cortisone injection.
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Hyalgan® and Synvisc® Injections.
Hyalgan®
and
Synvisc®
are proprietary names for medications
injected into the knee for mild to moderately severe osteoarthritis. The
injections are given in a series of five or three injections respectively
each week until the series is completed. You should embark upon the series
when you are unable to commit to the weekly office visits. We usually do
not recommend them until after cortisone has failed. You should rest a
couple days after the injection and apply ice to avoid soreness and swelling
after the injections.
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