Though casts are important for the healing process of fractures, they hold many disadvantages. Some of the disadvantages of casts include the need for frequent changes and re-evaluations, and the possibility of cast sores, which would preclude continued use of the cast. Other disadvantages lie in their weight, their opacity to X-rays and their susceptibility to damage by moisture.

Pressure Applied by the Cast.
Since a cast is custom fit to the patient and is non-removable, it is essential that the cast fit the limb properly. However, more often than not, the cast will be too tight or too loose to provide the required fixation.

When the cast applies too much pressure on the limb, it may cause:

• Increased pain
• Numbness and tingling in the hand or foot caused by excessive pressure on the nerves
• Burning and stinging, caused by excessive pressure on the skin
• Excessive swelling below the cast, which may mean the cast is slowing blood circulation, and in extreme cases this may lead to the loss of the limb
• Loss of active movement of toes or fingers, which requires urgent evaluation by a doctor
• Sores which will require removal of the cast

When the cast is too loose it does not provide proper fixation of the limb, thus increasing the risk of further complications and delaying the healing process due to unprotected movement.

Removal of the Cast.
Frequently the doctor will be required to remove the cast during the healing process. If the patient complains of pain, sores or tingling and there is a suspicion that the cast is too tight; or, if the patient suffers from open wounds due to injury that require treatment and medical inspection. In such cases the cast will be cut with a saw or similar tool and later will be applied again. This is a traumatic process to many patients, causing inconvenience and discomfort as well as delay in treatment.

Maintenance of the Cast.

• Plaster cast is heavy and burdensome to the patient.
• Does not provide any ventilation, which may cause irritation of the skin.
• Opacity to X-rays.
• The cast may become cracked or develop soft spots.
• Moisture weakens plaster and damp padding next to the skin can cause irritation.
• Difficulty to keep dirt, sand, and powder away from the inside of the cast.

This table compares between Plaster cast and Orthoflex brace.