A History of Orthopedic Casts and Broken Bones

A History of Orthopedic Casts and Broken Bones

Wearing a cast can be awkward, but there will be both benefits and detriments to having to wear an orthopedic cast.
Wearing a cast can be awkward, but there will be both benefits and detriments to having to wear an orthopedic cast.

Anyone who has ever had a broken bone, or suffered other serious injuries that require a cast knows how uncomfortable they can be, and the joy of finally getting the cast removed. What is not so well known is how the modern orthopedic cast was developed, and its history.

​When Were the First Orthopedic Casts Developed?

Medical Doctors take what is known as the Hippocratic Oath when they first become doctors. The oath itself stems from the teachings of the ancient Greek Hippocrates of Cos, who was renowned for his medical prowess, though to be fair, his accounts regarding the use of casts were actually based on ancient older Egyptian methods that he had observed and recorded for posterity.

In the interest of full disclosure however, Hippocrates of Cos also introduced his own ideas, above and beyond the practices of the ancient Egyptians. He stressed not only the need to splint broken bones, but also the importance of exercising the casted limbs in order to prevent muscle atrophy. The writings of Hippocrates regarding the continued exercising even of broken limbs would ultimately lead to what we now know as Physical Therapy.

The ancient Egyptians actually used some of the same techniques for healing broken bones, that were part of the embalming ritual, as frightening as that may sound today. The ancient Egyptians would create a second “skin” using tree bark, tightly binding it to the broken limb. This binding was then sealed with wax, resin, and other materials commonly used in the embalming and mummification though apparently many of the lessons learned were lost, or at least never undertaken by the European people solely for the purpose of resetting broken bones and allowing the bones to heal properly in an orthopedic cast.

The base materials of the orthopedic casts would change depending on the location, as would the materials used to harden the casts of old. Some of the older methods for hardening an orthopedic cast seemed more like kitchen recipes than medical techniques, involving such ingredients as lard, flour, eggs, and anything else that would harden the underlying material sufficiently well to allow the bones to heal.

When was the modern cast used to set broken bones for the first time?

When were the first casts used?
When were the first casts used?

It is good that war is so horrible, lest we become accustomed to it. This is paraphrasing an old General who is not so popular these days, though the maxim remains true to this day. Yet often in times of war, necessity results in innovations in the field of medicine that continue to serve long after the sound of the cannons has faded into the annals of history.

In other circumstances, such as this one, those innovations are merely recapturing or relearning that knowledge which had largely been lost during the dark ages. It is occasionally asserted that the modern orthopedic cast was first used during the 1850s, but this, as has been amply demonstrated here, is effectively nothing more than a return to the methods used more than two thousand years ago.

In the European nations and Russia, the most common recommendation for healing broken bones was resting in bed, depending on the patient not to move the limb housing the broken bones. The use of the orthopedic casts had largely been forgotten or never started to begin with in some of these areas of the world.

A French officer had been wounded during a battle, and the Naval doctor on the scene felt it was best that the arm be amputated, but lacked access to the proper tools to do the job apparently. Not to be dissuaded from his beliefs, French Naval doctor Dominique Jean Larrey enclosed the broken arm in what was effectively a cast and ordered that the Officer return at once to France to have the limb properly amputated in a safer environment.

The French officer in his cast was then sent from the battlefield, first to Russia, then through Poland into Germany, and ultimately into France. Much to the chagrin of the attending physicians, when the casts were removed, it was discovered that the bones had reset and fully healed. It was at this time that the use of the orthopedic cast became a viable means for allowing broken bones to heal throughout Europe and even in the then fledgling United States.

​Is the modern medical cast for broken bones the same as the original orthopedic casts were?

These “original” orthopedic casts were mostly made up of cloth bandages dipped in a plaster of paris that would harden around the broken limb. This method was extremely effective and popular and common all the way into the 1970s. At this time, the use of synthetic materials would become more common, leading to many innovations that would improve the composition of the orthopedic casts now commonly in use around the world.

The transition from cloth and plaster casts to the synthetic orthopedic casts did not happen overnight. In fact, to this day, there are still many places around the world that still use the plaster cast methods, and some places that use little more than a sling for broken arms. Most of the industrialized nations around the world commonly use the more popular synthetic materials for the orthopedic casts in the modern era.

​How Long Does it Take for Bones To Reset or Heal?

How long does it take for broken bones heal?
How long does it take for broken bones heal?

How long does a broken bone take to heal? It depends in large part on which bone is broken, how severe the break is, whether it is a simple fracture or a compound fracture, and far too many other factors to list in detail here. Not the least of these factors is how well the patient cares for the broken limb, and whether or not they will help or hinder the healing process.

Generally the actual time that the patient has to wear an orthopedic cast will be limited to anywhere between 3 to 6 weeks. Some orthopedic specialists may also recommend the use of a splint for a week or more before the cast is placed over the broken limb, largely to avoid swelling that may tend to go down, leaving the cast ineffective as the limb with the broken bone will be able to “rattle around” inside the cast.

​What are the Common Side Effects From Wearing a Cast?

It is very common for casts to become unpleasantly odoriferous, especially if the individual patient remains very active while wearing a cast. Yes, on the one hand, this is merely the result of sweat residual, but also due to the increased levels of bacteria that tends to build up.

You may be tempted to douse the affected area with antibacterial spray but this may not always be the best of ideas either. There may, in some rare cases, be a chemical reaction with the material of the cast itself. In such cases, this could easily exacerbate the underlying problem, while at the same time also causing entirely new medical challenges. It is best to ask the orthopedic doctor what his recommendations are while the cast is still new and before itching and smelling commence in earnest.

Bone fractures often result in swelling of the surrounding tissues. As the swelling may increase or decrease during the healing process, this may lead to what is commonly known as Compartment Syndrome, where the cast has bound too tightly and remains in constant contact with swollen tissue. This can lead to restrictions in blood circulation or other medical problems resulting from a tight cast. Conversely, when the cast is too loose, it may also create additional problems the cast bearer should be aware of.

Pressure sores are another common occurrence even with modern orthopedic casts. Pressure sores are common when the cast is long enough to cover joint areas where there may be some protrusion from the bone or joint. While it is most common with leg casts that extend beyond the knee, there may be cases where an arm cast extends beyond the elbow as well. Pressure sores may also result from a cast being place either too tightly or too loosely over the fractured appendage.

Among the most common symptoms of adverse reactions to the wearing of a cast are burning sensations, numbness or a tingling sensation that may occur anywhere along the limb or appendage, cold or pale skin that may be indicative of reduced blood flow, blue skin resulting from the inability of oxygenated blood to reach the affected area, or increased pain or swelling of the appendage.

If you experience any of these symptoms, you should consult your personal physician at the earliest possible convenience, or consider visiting the local emergency room before any additional damage or injuries are allowed to occur. While it may be extremely rare, these conditions could result in the need for amputation in the most severe of cases.

​What Is It Like When the Casts Are Removed?

What happens when a cast is removed?
What happens when a cast is removed?

When the cast is removed the skin may be pink, and even exceptionally tender, depending on the extent of any injuries that may have occurred in conjunction with the fracture, such as injuries as may be the result of a violent and fiery vehicle accident.

The skin may also have a different scent when the cast is removed, and this may be unpleasant at first. There may be additional differences noted in the hair on the appendage, and it usually results in the hair being darker in appearance, and perhaps even appearing thicker on the limb.

There may also be an associated sense of lightness with the limb seeming to elevate on its own. This is because the body has had time to adjust to the weight of the cast, and when it is removed the muscles will continue to attempt to adjust to the weight, largely due to muscle memory.

​What is the Best Way to Care for Your Cast?

What is the best way to care for your cast?
What is the best way to care for your cast?

The first and most important step for taking care of your cast is to listen to the recommendations of the orthopedic doctor who puts it on in the first place. Also it is a good idea to make a contingency for an appointment immediately upon noticing any of the symptoms of an improper fitting that were previously discussed.

If perhaps you have broken a bone while traveling to more rural or isolated locations, you may end up with a plaster cast. The old plaster casts are extremely prone to being damaged from excessive levels of moisture. The old style plaster casts may also break more easily than their modern fiberglass and synthetic counterparts.

Most casts can be dried with a common hair dryer in the event they get wet, but care should be taken not to use the highest settings, and to avoid getting the dryer too close to the cast itself. This can be especially tempting in cases where the skin is also moist, and getting “clammy” inside the cast and that hot air provides such a relief.

Heating the cast directly may result in the materials expanding, contracting, or even cracking, preventing it from doing its job and potentially leading to additional medical issues that could have been avoided. The material may have already swelled as it absorbed water, and will expand further if it gets heated to any significant degree.

Casts should also be covered when possible, so as to avoid the potential for dust, dirt, and of course, the ever-present small toys or other objects from dropping down inside the cast. The cast should also be kept clean, and you should avoid placing too much weight on any cast that was not specifically designed for such pressures. This is largely related to walking on a leg cast, but may be relevant in other scenarios as well.

​Can Modern Orthopedic Casts be Submerged Without Damage?

The introduction of synthetic cast materials in the 1970s has allowed for the introduction of orthopedic casts that can generally be submerged without any negative consequences. However, it is always a good idea to check with your orthopedic medical specialist as there are variables that will always have to be considered.

Someone who lounges poolside during their recovery from broken bones may have fewer concerns than an avid surfer who will be wearing an arm cast into the ocean for eight or ten hours every day. The short answer is yes, but as is always the case with any type of medical concern, there should never be any exception and licensed and certified medical specialists should always be consulted.

​How Long Does it Take Muscles to Atrophy In an Orthopedic Cast?

Water stores and glycogen in the muscles begins dissipating rapidly when the muscles are not used, but muscle atrophy generally takes about two weeks before it sets in noticeably. Exercise may or may not be a viable option while the patient is wearing a cast, and as always, the medical professionals and ideally the orthopedic specialist who put on the cast should be consulted before commencing any physical therapy either privately or through your medical service provider.

Even the largest bones will heal in a relatively short amount of time, and muscle atrophy is generally a very minor concern for the average person with a broken bone. Some professional athletes, bodybuilders and others may have a more noticeable result from muscle atrophy while wearing a cast, but the muscle mass can generally be quickly regained once the orthopedic cast has been removed.

​Why Don’t Cast Saws Cut Human Skin?

If you have ever had a cast removed, you may have shrunk back in horror when the cast saw first touched your skin. Now let us make that even more scary for you, before we comfort you just a little bit at least. The saws that are used to cut off orthopedic casts will cut human flesh. However, in order to do so, the person operating the saw would have to make a physical effort to cut the person.

The reason that the saws used to remove the orthopedic casts do not generally tend to cut skin, is that they have a recessed blade, and a sufficient amount of pressure must be applied to allow the blade to be exposed enough to cut. In other words, the person removing the cast would have to literally press the saw firmly into the flesh to allow it to cut.

A larger concern should be the friction burns that can occur when the cast is tight or the saw is operated too close to the skin. The outer dermal tissue can receive friction burns even without direct contact. This was surprisingly common in the days of the fiberglass casts, as the fiberglass does not absorb heat so much as deflect it. With the new synthetic cast materials however, even this minor discomfort is easily avoided and should not be a concern worthy of any real merit.

​Does AHCMD Have Orthopedic Surgeons?

The Advanced Health Care Orthopedic Department is staffed only by highly trained, professional and experienced orthopedic doctors. Whether you just need a medical consultation with an Orthopedic specialist or require the services of an experienced Orthopedic Surgeon, AHCMD can help you to find the right doctor right away.

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