Athletes and Casts

Oftentimes, in the course of a year athletic trainers are faced with an athlete who has a fracture.  Sometimes it is season ending, sometimes there is enough time for recovery and return.  Other times the athlete may continue, provided they meet certain criteria.  In the case of an athlete with a cast, the continued participation is usually dependent on the rules of that sport.  Being able to protect opposing players from harm is usually the number one consideration.  Athletes who can continue to participate present their own set of problems for the athletic trainer.  

While fiberglass casts where a great innovation, the underlying cotton padding and stockinette is the same system used for the old plaster casts.  While the actual fiberglass casting material is impervious to water the cotton padding cannot become saturated with water.  Doing so leads to the deterioration of the skin and possible infection.  An athlete practicing with a cast accumulates sweat and dirt over time, increasing the potential for a harmful outcome.  Over time the cast will become a petri dish for bacteria.  I had one athlete tell me that his cast smelled so bad that it woke him while he was asleep.


There are a couple of options that the athletic trainer can pursue to deal with this scenrio.  In both cases it takes a cooperative physician to accomplish.  


The Bivalve - After an athlete has been fitted for a cast and it begins to deteriorate ecologically, you send them back to the doctor for a new cast.  The doctor then bivalves the cast and a new one is applied.  The new cast is also immediately bivalved.  The athlete now has two removable casts.  The original and now smelly cast for practice and competition, and a new one which is now presentable in mixed company.  


This procedure requires a physician comfortable doing this and a fracture that is far enough along in its healing.  You also need a responsible athlete who will continue to wear the cast since they can now remove on their own.  The athletic trainer only needs to apply the casts at the beginning and conclusion of activity.  Tape is all that is usually required to join the two pieces for a stable device.


Cast Liner - The other option is to use some new products that make the underlying cast padding also water proof.  These products are applied just like the traditional cotton padding but are now water proof.  The athlete can practice in them and then go into the shower without any protective cover.  In fact that is preferably as the shower will help rinse out any accumulated dirt and sweat.  Many doctors do not carry this product because of reimbursement issues with insurance companies.  I have used the Gore Tex PROCEL cast Liner for a number of years.  I purchase this myself and when I have an athlete who is to be casted I send along some rolls of the material for my doc to use.  It works out well.


Besides PROCEL there are a couple of other products now on the market. PROCEL. Here are the links:


     Gore Tex PROCEL

    3M™ Scotchcast™ Wet or Dry Cast Padding

    BSN Deltra Dry