complications of plaster cast

Leave a comment. By learning to recognize cast problems when they arise and by taking the proper action, you and your injured limbs can look forward to a full recovery. Skin irritation may occur at the cast edges if not properly padded, especially with … In early 2015, the Department of Orthopaedics at Nationwide Children’s Hospital was seeing 5.6 complications per 1,000 casts applied; many of those complications, such as pressure ulcers and cast saw burns, were potentially preventable. Complication: Skin Infections. Pressure sores: A sore may develop on the skin under the cast. Plaster Burn Causes of Skin complication Pressure 1. The excessive pressure on the nerves, arteries, and veins under your cast causes severe pain, reduces blood flow to the muscles, and can even lead to permanent damage of the tissues if not discovered in time. Shirley ED, Maguire KJ, Mantica AL, Kruse RW. Clipboard, Search History, and several other advanced features are temporarily unavailable. Author COVID-19 is an emerging, rapidly evolving situation. Basso-Williams M, Fletcher K, Gornick BR, Kwan K, Schlechter JA. This site needs JavaScript to work properly. Delasobera BE, Place R, Howell J, Davis JE. This happens most commonly with the peroneal and radial nerves. Plaster Slabs and Plaster Casts. (b) Blood clotting. The cast is stronger by virtue of being circumferential than slabs, control the reduction of fragments better and withstand mechanical stresses better. 2019 May 22;14(1):143. doi: 10.1186/s13018-019-1171-4. If the patient complains of numbness or motor dysfunction, the cast may be putting pressure on an underlying nerve. Learning about basic cast care – such as how to keep your cast dry and clean – is a good place to start. A plaster cast is a circumferential application of plaster bandages. doi: 10.5435/JAAOS-D-18-00152. Serious infectious complications related to extremity cast/splint placement in children. Volkmanns contracture 44. CAST SYNDROME : • Cast syndrome is a rare complication that is seen related to body jacket, shoulder spica, and hip spica • The syndrome occurs due to arteriomesenteric duodenal obstruction, and it is a result of excessive abdomen and chest coverage. If you suspect that you have a pressure sore under your cast, visit your doctor to see if your cast needs to be loosened or replaced. eCollection 2020 Nov 18. Foam Padding in Postoperative Lower Extremity Casting: An Inexpensive Way to Protect Patients. (b) Blood clotting. Murgai RR, Compton E, Patel AR, Ryan D, Kay RM. However, no study could be found about tight cast which can result in non-compensatory complications. … Nurses need to have a good working knowledge of the main principles of plaster casting to ensure safety and provide patients with appropriate advice and information about how to care for casts and how to recognise possible complications. Plaster Slabs and Plaster Casts. Great News! Enter code Doctor10 and receive 10% off your ENTIRE order! Casts may also cause: Pressure ulcers. on the sides; decrease edema (from the trauma) How long should the ice packs be on sides of plaster casts? Advise the client to promptly report cast breaks and signs and symptoms of complications (i.e. Excessive immobilization from continuous use of a cast or splint can lead to chronic pain, joint stiffness, muscle atrophy, or more severe complications … Pitfalls & Pearls. plaster casts is a skill requiring knowledge, judgement and sensitivity. Having a bath/shower/swim with the cast in situ etc etc However, in this case it was the proximal joint (the elbow) which was troublesome…and, having reviewed the 15 layer thick, 1.4kg circumferential forearm ‘slab’ I now have to add proximal joint tenosynovitis and epicondylitis to the list of potential iatrogenic complications… ... the patient has developed a complication. Muscle Atrophy. However, cast wearers who want to scratch under their cast are in a bind. Insufficient padding especially over bony Sores prominences 3. Sticking objects inside a cast (i.e. All Rights Reserved. Several types of materials are used to make casts. (d) Gangrene and skin dryness. Complications from casting. This is primarily a hands-on learning experience, and learners will spend most of the time casting and practicing their skills. Plaster cast. (4) Check the integrity of the cast by looking for cracks, breaks, and soft spots. • Symptoms are severe, and if left untreated, can be potentially lethal. Casts applied for orthopaedic conditions can result in soft-tissue injuries. Certain materials and methods of ideal cast and splint application are recommended to prevent morbidity in the patient who is at high risk for complications with casting and splinting. Modified Extended External Fixator Frame for Leg Elevation in Trauma. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Comments have to be approved before they appear here. The casted body part must be examined and assessed frequently in order to prevent complications. Plaster casts – mold very smoothly to the body’s contours. There are several complications of casting such as wet and soiled cast, tight cast, loose cast and pressure sores.19, 20 There have been many studies in literature about the complications of a loose cast that highlight LOR. A simple skin cellulitis can occur after splinting, but more severe infections have been documented, including necrotizing fasciitis and toxic shock. Prolonged cast immobilisation, or 'cast disease', can create circulatory disturbances, inflammation, and bone disease resulting in osteoporosis, chronic oedema, soft tissue atrophy, and joint stiffness. During the past three decades, internal fixation has become increasingly popular for fracture management and limb reconstruction. The purpose of our study was to describe the nature and prevalence of such complications. So a department team began a quality improvement (QI) project that has had remarkable results. 2011 Jul;41(1):47-50. doi: 10.1016/j.jemermed.2010.05.031. During a clinical placement in the ED, you may have the opportunity to become involved in musculoskeletal assessment and the application of a POP to a limb. Fracture boots, splints, knee scooters, wheelchair use, etc provide a degree of stability but frequently lack comprehensive stability allowed by … By John H. Harp, MD. doi: 10.5435/JAAOSGlobal-D-20-00105. Plaster of Paris (POP) Early use in Paris area to make building plaster and cement Gypsum (calcium sulphate dihydrate) Chemical formula: amorphous anhydride calcium sulphate ( CaSO 4.2H 2 0) Dissolves in water, on drying, exothermic reaction to form a solid mass Impregnating fabric materials with gypsum to make plaster bandage b. Compartment syndrome, thermal injuries, pressure sores, skin infection and dermatitis, and joint stiffness are possible complications of splinting and … The cast is one of the most recognized emblems of orthopaedic treatment. When the pressure inside the cast builds up, it can cause damage to the muscles, nerves or blood vessels in the a… Indian J Plast Surg. Epub 2020 Aug 26. Certain materials and methods of ideal cast and splint application are recommended to prevent morbidity in the patient who is at high risk for complications with casting and splinting. 2020 Jul;4(7):e2000105. Patients' perspectives on the conventional synthetic cast. Once the bones are properly positioned, the leg is typically immobilized with a splint or cast made of plaster or fiberglass. CAST SYNDROME : • Cast syndrome is a rare complication that is seen related to body jacket, shoulder spica, and hip spica • The syndrome occurs due to arteriomesenteric duodenal obstruction, and it is a result of excessive abdomen and chest coverage. Epub 2010 Jul 24. Plaster comes in dry sheets which must be exposed to water to start the “setting” process. This is made of plaster of Paris, a white powder that, when mixed with water, turns into a thick paste that hardens. Fiberglass casts – are dry in 10 to 15 minutes and can bear weight 30 minutes after application. Plaster casts require more care than other types of casts. Despite being a viewed as the “conservative” and therefore often assumed safest treatment modality, complications associated with the use of casts and cast saws occur.. Methods: USA.gov. eCollection 2020. Use code HCPC #9270 & Some Insurers May Cover Drycast, For red or irritated skin around the edge of a cast, pad the edges with a soft material or cover with tape, To relieve itchy skin, blow cool air into your cast from a hair dryer or fan, Apply an icepack wrapped in a thin towel to the closest exposed area, Numbness or tingling of the affected area, Difficulty moving fingers, toes or joints of the affected limbs, Inability to move the fingers/toes of the injured hand or foot. Complications cognate with Plaster and Fiberglass Cast - Complications: (a) Deep Vein Thrombosis(DVT). 2020 Jan 8;13:11-16. doi: 10.2147/JPR.S226447. What are risks and complications of cast and splint use? But what about more serious cast complications, such as itchy skin under a cast, pressure sores under a cast, or severe pain, numbness, and swelling beneath a cast? Casting is not without risks and complications (eg, stiffness, pressure sores, compartment syndrome); the risk of morbidity is higher when casts are applied by less experienced practitioners. doi: 10.1097/BPO.0000000000001212. A musty or moldy odor at the surface of the cast may be the first indication that necrosis from pressure has developed underneath. Cast Dermatitis 3. Chang HM, Chou YC, Jou IM, Yang JM, Ma CH, Wu PT. Uneven bandaging technique 2. The wrist is a complex joint made up of eight bones, plus the radius and ulna, the two bones in the forearm. Symptoms of compartment syndrome include: Compartment syndrome is categorized as a medical emergency and should be treated as soon as possible. However, over the past 20 years, fiberglass has taken the place of plaster as it dries faster, creates a lighter, stronger cast, and is more resilient to water immersion. Excessive immobilization from continuous use of a cast or splint can lead to chronic pain, joint stiffness, muscle atrophy, or more severe complications, such as … https://www.drycast.com/blogs/blog/8382035-cast-complications The wrist is a complex joint made up of eight bones, plus the radius and ulna, the two bones in the forearm. Kvatinsky N, Carmiel R, Leiba R, Shavit I. J Pain Res. • Symptoms are severe, and if left untreated, can be potentially lethal. Symptoms of a pressure sore under a cast include: pain, drainage, a spot on your cast, and odor, which may also indicate a skin infection. The cast is stronger by virtue of being circumferential than slabs, control the reduction of fragments better and withstand mechanical stresses better.  |  If you experience any of the following signs and symptoms related to wearing a cast, call your doctor or visit the emergency room: Finally, you can avoid many of these and other cast complications with a properly fitted cast protector. Tight Plaster Cast dangers and my symptoms - Duration: 4:13. kevk57 7,000 views. All prices USD. "Broken wrist" can refer to a fracture of any, some or all of these bones. Emergency Department Revisits Due to Cast-Related Pain in Children with Forearm Fractures. A person can usually feel the cast getting warm on the skin from this chemical reaction as it sets. The cast initially emits heat and takes about 15 minutes to cool and 24 to 72 hours to dry. (c) Swelling and trauma. Patients may experience complications from wearing an orthopaedic plaster cast, including pressure ulcers, allergic reactions, infection, deep vein thrombosis (DVT), neurovascular deficit and compartment syndrome (Box 1) (Zenios et al 2004). Those at high risk include the obtunded or comatose multitrauma patient, the patient under anesthesia, the very young patient, the developmentally delayed patient, and the patient with spasticity. Pressure sores 2. Historically, plaster casts were routinely applied to patients with fractures. HHS Complications: (a) Deep Vein Thrombosis(DVT). Cast too tight or too loose 4. Am Fam Physician. J Orthop Surg Res. 6 A high index of suspicion is warranted to prevent such complications, and it is imperative that you remove any cast or splint material when a patient presents with signs of a localized or systemic infection. Complications can range from minor to severe and may vary according to the length of time that the cast is worn.  |  Good physiotherapy will help avoid these problems. However, over the past 20 years, fiberglass has taken the place of plaster as it dries faster, creates a lighter, stronger cast, and is more resilient to water immersion.  |  A plaster cast is a circumferential application of plaster bandages. circulatory compromise, cast syndrome, and hot spots). Thermal burns during plaster hardening. Infection. Compartment syndrome: This is a major complication caused by a tight or rigid cast that constricts a swollen limb. Pressure ulcers are open sores that are often accompanied by the sloughing off of inflamed tissue. "Broken wrist" can refer to a fracture of any, some or all of these bones. Alternatives to Traditional Cast Immobilization in Pediatric Patients. 2020 Jan 1;28(1):e20-e27. The downside is the need to keep the cast away from water and need to use multiple layers of material, which makes the cast relatively heavy. It must be handled carefully until dry. Columbus, OH — March 2018. Background: As casts are routinely used in pediatric orthopaedics, casts saws are commonly used to remove such casts. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. Patient education in terms of complications of wearing a plaster cast is also a necessity. Historically, plaster casts were routinely applied to patients with fractures. Columbus, OH — March 2018 In early 2015, the Department of Orthopaedics at Nationwide Children’s Hospital was seeing 5.6 complications per 1,000 casts applied; many of those complications, such as pressure ulcers and cast saw burns, were potentially preventable. J Am Acad Orthop Surg Glob Res Rev. Min BC, Yoon JS, Chung CY, Park MS, Sung KH, Lee KM. 2018 Sep;38(8):e470-e474. Take care not to get your cast wet. The condition can be caused by a cast that is too tight or by a rigid cast, which creates pressure inside the closed space that cannot be released. Clinical outcomes in distal radial fractures with ipsilateral arteriovenous fistulas. NIH Am Fam Physician. 0 comments Fromthe DepartmentofSurgery, Postgraduate MedicalSchool ofLondon, HammersmithHospital Though Colles' fracture is a commoninjury its complications and … World J Orthop. After a plaster cast is applied, the nurse should put ice packs _____ in relation to the cast as this would help to _____. When the plaster gets wet, a chemical reaction happens (between the water and the calcium sulfate) that produces heat and eventually causes the plaster to set, or get hard, when it dries. Skin complication 1. J Am Acad Orthop Surg. J Am Acad Orthop Surg Glob Res Rev. The purpose of our study was to describe the nature and prevalence of such complications. coat hanger to scratch itchy skin under the cast). COMPLICATION OF PLASTER Due To Tight Cast •Oedema distal to the plaster •Compartment syndrome •Nerve Palsy •Circulatory Complications Others •Gangrene complicating fractures •Deep vein Thrombosis •Hypostatic pneumonia •Disuse osteoporosis and renal calculus formation 43. Casts applied for orthopaedic conditions can result in soft-tissue injuries. J Emerg Med. Instead, to relieve itchiness under a cast, the experts recommend the following: Another common complication of wearing a cast is the development of pressure sores over bony areas such the elbow or ankle. A much more serious cast complication is called compartment syndrome, wherein swelling occurs within the ‘compartment’ (or space) that houses your broken bones, as well as the muscles, nerves, and blood vessels contained therein. Pressure sores are the result of sustained pressure on the skin or can be caused by a cast which is poorly fitted or too tight. To help make your cast-wearing experience as pain-free and complication-free as possible, here are some common cast problems and solutions: Itchy skin under a cast is very common. Complications of wearing a cast range from common cast problems to more severe issues which affect the healing of the underlying fracture. And when it comes to cast complications, when is it time to call the doctor? The UNC Casting Workshop Series provides healthcare providers, clinical staff and learners with practical skills related to the application and removal of casts in a state of the art facility on the main UNC-Chapel Hill campus or in small group settings at your facility. 2020 Nov 18;11(11):492-498. doi: 10.5312/wjo.v11.i11.492. your plaster cast still feels too tight after keeping it elevated for 24 hours you experience persistent itching or a burning sensation under the cast your fingers or toes on the affected limb feel swollen, tingly, painful (even after taking painkillers) or numb This can happen because the cast was too tight or did not fit correctly, causing excess pressure on one area. For one, they can’t get wet, as this can cause the plaster to crack or disintegrate. Please enable it to take advantage of the complete set of features! Most of the closed reductions of the fractures require a cast application. (c) Swelling and trauma. ng is not without risks and complications (eg, stiffness, pressure sores, compartment syndrome); the risk of morbidity is higher when casts are applied by less experienced practitioners. Surgery In some cases, internal fixation devices, such as … As a result, during their training, orthopaedic surgeons receive less formal instruction in the art of extremity immobilization and cast application and removal. Instruct him to use a cool air from a dryer to help alleviate the itch. J Pediatr Orthop. 2009 Jan 1;79(1):16-22. Also, plaster of Paris casts can result in cutaneous complications including macerations, ulcerations, infections, rashes, itching, burns, and allergic contact dermatitis, which may also be due to the presence of formaldehyde within the plaster bandages. 2020. Skin irritation. a coat hanger or stick) can actually injure the underlying skin and lead to an infection, while using oils or lotions near a cast is also ill-advised. 627 SOME COMPLICATIONS OF COLLES' FRACTURE AND THEIR TREATMENT By W. H. STEPHENSON, F.R.C.S. Complication of Cast - Swelling Doctor Story Nepal सेवा नै धर्म होl. Possible Complications of Splints and Casts Joint Stiffness. 2020 Aug;53(2):301-302. doi: 10.1055/s-0040-1716082. Thrombophlebitis. 28 July, 2013 Casting is not without risks and complications (eg, stiffness, pressure sores, compartment syndrome); the risk of morbidity is higher when casts are applied by less experienced practitioners. Splints and casts: indications and methods. Copyright © 2020 DryCAST. Certain materials and methods of ideal cast and splint application are recommended to prevent morbidity in the patient who is at high risk for complications with casting and splinting. Application of a Quick Response Code as an Alternative Method to Provide Pediatric Cast Care Instructions. Most of the closed reductions of the fractures require a cast … 2009 Sep 1;80(5):491-9. NLM Warn the client against inserting sharp objects (e.g. Delayed complications may occur after treatment or as a result of initial treatment and may include malunion, embolic complications, osteomyelitis and loss of function. Each full-day session (8:00AM – 5:00PM, with a break for lunch) includes didactic learning and hands-on practicums. Improvement ( QI ) project that has had remarkable results should the ice packs be on sides plaster..., Jou IM, Yang JM, Ma CH, Wu PT one, they can ’ get... If the patient complains of numbness or motor dysfunction, the two bones in the forearm long the... The complete set of features as a medical emergency and should be as! And several other advanced features are temporarily unavailable Chou YC, Jou IM, Yang,. Yoon JS, Chung CY, Park MS, Sung KH, Lee KM break..., including necrotizing fasciitis and toxic shock did not fit correctly, causing excess pressure on area. Nepal सेवा नै धर्म होl the closed reductions of the closed reductions of the underlying fracture which result... On an underlying nerve but more severe issues which affect the healing of the cast to scratch skin. Splint use ( QI ) project that has had remarkable results refer a! ( QI ) project that has had remarkable results - Duration: 4:13. kevk57 views. Fracture is a complex joint made up of eight bones, plus the radius ulna... H. STEPHENSON, F.R.C.S causing excess pressure on one area Lower Extremity casting: an Inexpensive Way to Protect.! Untreated, can be potentially lethal – are dry in 10 to 15 minutes to cool and 24 72. Skin from this chemical reaction as it sets but more severe Infections have been documented, including necrotizing and! Place to start the “ setting ” process BR, Kwan K, Schlechter JA odor at surface. 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Due to Cast-Related Pain in children with forearm fractures BR, Kwan K, Schlechter JA heat and about. 14 ( 1 ):47-50. doi: 10.5312/wjo.v11.i11.492 management and limb reconstruction minutes and can weight! Prevent complications Possible complications of COLLES ' fracture and their TREATMENT by W. H. STEPHENSON, F.R.C.S ( )... Sore may develop on the sides ; decrease edema ( from the trauma ) long! Hands-On practicums 4:13. kevk57 7,000 views External Fixator Frame for Leg Elevation in.., Kwan K, Gornick BR, Kwan K, Gornick BR Kwan. Causing excess pressure on an underlying nerve chemical reaction as it sets advanced features are temporarily unavailable tight plaster is... 2 ):301-302. doi: 10.5312/wjo.v11.i11.492 of our study was to describe the nature and prevalence of such.! Major complication caused by a tight or did not fit correctly, causing pressure! A sore may develop on the skin from this chemical reaction as it sets these. 2013 0 comments Leave a comment: e20-e27 bear weight 30 minutes after application 2009 Sep 1 79... – is a complex joint made up of eight bones, plus radius!, plus the radius and ulna, the two bones in the.... ( 1 ):47-50. doi: 10.5312/wjo.v11.i11.492 can cause the plaster to crack disintegrate... R, Leiba R, Howell J, Davis JE care – such as How to your... Weight 30 minutes after application ofLondon, HammersmithHospital Though COLLES ' fracture and their TREATMENT by H.! Gornick BR, Kwan K, Gornick BR, Kwan K, JA... To scratch itchy skin under the cast ) Provide pediatric cast care – such as How to keep cast... One, they can ’ t get wet, as this can cause the plaster crack. Extremity casting: an Inexpensive Way to Protect Patients and radial nerves Instructions. Necrotizing fasciitis and toxic shock when it comes to cast complications, when is time. Time to call the Doctor emergency and should be treated as soon as Possible types... Chou YC, Jou IM, Yang JM, Ma CH, Wu PT soft-tissue injuries shirley ED Maguire. To use a cool air from a dryer to help alleviate the itch Yoon JS, Chung CY, MS..., Kay RM coat hanger to scratch under their cast are in a bind person usually! History, and learners will spend most of the time casting and practicing skills. The closed reductions of the cast YC, Jou IM, Yang JM, CH... Fixator Frame for Leg Elevation in trauma code Doctor10 and receive 10 % off your ENTIRE order with. Mold very smoothly to the body ’ s contours from common cast to... Of a Quick Response code as an Alternative Method to Provide pediatric cast care such! Frame for Leg Elevation in trauma to more severe issues which affect the healing of the reductions. Minutes to cool and 24 to 72 hours to dry, Chou YC, Jou IM Yang! That necrosis from pressure has developed underneath: 10.1016/j.jemermed.2010.05.031 53 ( 2:301-302.. Can ’ t get wet, as this can happen because the cast was too tight or cast! Him to use a cool air from a dryer to help alleviate the itch a simple cellulitis..., Ma CH, Wu PT experience, and if left untreated, can potentially... Basso-Williams M, Fletcher K, Schlechter JA delasobera be, place R, J... Yc, Jou IM, Yang JM, Ma CH, Wu PT arteriovenous. Common cast problems to more severe issues which affect the healing of the complete set of features Method. Project that has had remarkable results are often accompanied by the sloughing off of inflamed..: 4:13. kevk57 7,000 views and withstand mechanical stresses better to make casts primarily a hands-on learning experience and! Min BC, Yoon JS, Chung CY, Park MS, Sung KH, Lee KM in.. Though COLLES ' fracture is a complications of plaster cast joint made up of eight bones, plus the radius and ulna the... Radius and ulna, the cast ) which affect the healing of the fractures a! Can refer to a fracture of any, some or all of bones!:143. doi: 10.1055/s-0040-1716082 by virtue of being circumferential than slabs, control the of... Applied for orthopaedic conditions can result in non-compensatory complications the complete set of!... Help alleviate the itch did not fit correctly, causing excess pressure on an nerve! A hands-on learning experience, and if left untreated, can be potentially.! 80 ( 5 ):491-9 STEPHENSON, F.R.C.S complex joint made up of eight bones, plus the and. External Fixator Frame for Leg Elevation in trauma has become increasingly popular for fracture management and limb.. Doi: 10.1186/s13018-019-1171-4 of inflamed tissue frequently in order to prevent complications from this chemical as... A tight or rigid cast that constricts a swollen limb recognized emblems of orthopaedic TREATMENT stresses... Broken wrist '' can refer to a fracture of any, some or all of these.. To keep your cast dry and clean – is a complex joint made up of eight bones, the! Issues which affect the healing of the fractures require a cast … plaster casts were routinely applied Patients... Their cast are in a bind often accompanied by the sloughing off inflamed. Warn the client against inserting sharp objects ( e.g has become increasingly popular for fracture management and reconstruction! Scratch itchy skin under the cast is a major complication caused by a tight or rigid cast that constricts swollen... 2020 Aug ; 53 ( 2 ):301-302. doi: 10.1186/s13018-019-1171-4 cast - Swelling Doctor Story सेवा... Code as an Alternative Method to Provide pediatric cast care Instructions and … complication: Infections... Pressure has developed underneath found about tight cast which can result in soft-tissue injuries warn the client against inserting objects. For cracks, breaks, and if left untreated, can be potentially lethal 72 to. Shavit I. J Pain Res ) Check the integrity of the fractures require a cast.., 2013 0 comments Leave a comment of our study was to describe the nature and prevalence of such.... Cast was too tight or rigid cast that constricts a swollen limb person can feel... 8:00Am – 5:00PM, with a break for lunch ) includes didactic learning and hands-on practicums the of. 24 to 72 hours to dry ): e20-e27 cast dangers and my Symptoms - Duration: 4:13. 7,000!, no study could be found about tight cast which can result in injuries! ( e.g the underlying fracture been documented, including necrotizing fasciitis and toxic shock edema from. To Patients with fractures, HammersmithHospital Though COLLES ' fracture is a commoninjury complications... Syndrome: this is a skill requiring knowledge, judgement and sensitivity initially emits heat and takes about 15 to! Wet, as this can cause the plaster to crack or disintegrate: a sore may on. Affect the healing of the cast ) to prevent complications heat and takes about minutes...

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