Casting: Leaving Physicians in the Dark

“I love my ActivArmor. I got rashes under all the other ones.”

Stacy Trujillo, Patient, Centura Pueblo

The lack of visualization under a cast leaves physicians in the dark as to the condition of the skin and the degree of immobilization under the cast.

Bone fractures must be stabilized in proper alignment for proper healing. Physicians often choose to use fiberglass or plaster casts, over splints, to immobilize acute injuries, because they are protective and non-removable. However, there are some serious issues with this traditional form of immobilization, including hygienic aspects (such as the inability to clean and monitor the skin for reaction or infection) and mechanical aspects (variability in wrist/hand movement due to changes in edema).

The lack of visualization of the affected area leaves both patients and physicians in the dark as to the condition of the skin and the degree of immobilization or amount of movement allowed under the cast.

Variations in edema during the first few weeks of an acute injury can change the ability of the cast to immobilize effectively. When asked about the duration of swelling, Dr. Robert Daher, from New York Upstate Medical University, responded:

“Days to weeks. Many variables are taken into consideration; type of fracture, mechanism of injury and treatment (closed manipulation vs surgery). Generally, you can expect to have swelling for a few weeks.”

He suggested that an orthopaedist should determine the proper method of immobilization during this period. In some cases, adjustable splints are used to accommodate changes in swelling, but the risk of injury due to the device being less protective and non-compliance issues are introduced, especially in pediatrics. In addition, off-the-shelf, low temperature thermoplastic devices can deform or be adjusted incorrectly by the patient, and some must be removed to wash and dry, leaving the injury unimmobilized for periods of time during the healing phase.

ActivArmor is currently collaborating with research institutions to test the fit and immobilization efficacy of traditional casts versus our digitally fit orthoses, using MRI imaging to measure gaps between the patient’s skin and the immobilization device.

The hygienic aspects of being breathable, washable and waterproof* are game-changing, because moisture and bacteria being trapped against the skin can cause irritation and infections. The custom design options allow for exposure of post surgical hardware or incisions, or skin lacerations for observation and treatment. And the breathable design allows for real-time observation and adjustments to fit throughout the course of the healing phase.

ActivArmor™ is breaking the mold of traditional casting by giving physicians the ability to observe acute injuries while being immobilized, to treat any skin issues, and to make ongoing fit adjustments due to changes in edema, for improved healing outcomes.

While ActivArmor may not be appropriate for use in the first phase of healing, where a fracture is unstable and requires reduction/realignment, it is successfully being used by physicians in cases of non-displaced fractures, soft tissue injuries, and in later healing phases for more severe fractures. It can be bi-valved in the case of subsequent swelling, and because it does not need to be removed to clean or dry like some “waterproof” braces on the market, physicians can rest assured that the injury will be supported throughout the required healing phase.

Visit our website at www.ActivArmor.com for more information.

* Waterproof is relative upon pressure and depth of water exposure.

“You don’t get the skin breakdown that you do with traditional casts. Less risk of infection; you can view the incision as well as pin sites, where you can’t monitor those in a traditional cast. So these are great for post-op patients.”

Jason Browder, PA, Alpine Orthopaedics, Gunnison, CO