Jonathan Cluett, MD, is a board-certified orthopedic surgeon with subspecialty training in sports medicine and arthroscopic surgery.

Michael Menna, DO, is a board-certified, active attending emergency medicine physician at White Plains Hospital in White Plains, New York.

Angela Underwood's extensive local, state, and federal healthcare and environmental news coverage includes 911 first-responder compensation policy to the Ciba-Geigy water contamination case in Toms River, NJ. Her additional health-related coverage includes death and dying, skin care, and autism spectrum disorder.

Casts are often an important part of the management of broken bones. However, problems can arise when wearing a cast. These issues may go unnoticed and worsen unless you spot the signs and report them to your healthcare provider. It is not just pain you should be concerned about—but also signs of infection, excessive swelling, or an improperly fitted cast that may affect bone healing.

A properly fitted cast should fit comfortably for the duration of the treatment period. There may be some itching and aches as the bone starts to heal, but new or worsening pain is a sign that something is wrong.

This article looks at some of the potentially serious problems that can occur while wearing a cast. It also lists the signs and symptoms that warrant an immediate visit to your healthcare provider.

One of the most challenging aspects of having a cast is keeping it dry. While there are waterproof casts and cast materials made to tolerate moisture, most people are still encouraged to keep the cast dry.

Some casts can become damaged by water, but the more serious problem is the potential for skin maceration , which is when the skin starts to break down. Water that's trapped in your cast can lead to skin damage.

Skin maceration can cause itchiness as well as the development of sores and cracks. This, in turn, can lead to skin infections.

If you get water under your cast and it wasn't made to tolerate water, you should let your healthcare provider know—because the cast may need to be replaced.

Signs of infection warrant immediate care. These include a fever, soreness, pain, redness, skin warmth, a foul smell, or pus underneath the cast or extending beyond it.

Another complication of wearing a cast is pressure sores, also known as pressure ulcers. These tend to develop over bony areas, such as the ankle or elbow. They are caused by sustained pressure on the skin, often when a cast is poorly fitted.

Pressure sores may cause pain, and can lead to skin infections and bleeding. Skin infections can often be recognized by a foul odor and/or the drainage of fluid from underneath the cast. There may also be a visible spot on the cast as the drainage or bleeding seeps through.

If you suspect that you have a pressure sore under your cast, see your healthcare provider. The cast may need to be loosened or replaced.

A rare but more serious cast-related complication is compartment syndrome. This occurs when a cast is too tight, causing pressure within the cast that cannot be released. This may compress nerves and blood vessels and can reduce blood flow to tissues.

Symptoms of compartment syndrome are:

If not recognized and treated appropriately, compartment syndrome can cause permanent nerve injury and tissue necrosis (death).

If you have any of the following symptoms, it could be a sign of a cast-related complication that needs immediate medical attention:

Casts aid in the healing of bones but may cause problems if the cast gets overly soaked or is improperly fitted. This can lead to skin maceration (in which saturated skin starts to break down), pressure sores (typically on bony parts of the body), and compartment syndrome (caused when a tight cast cuts off blood circulation).

If left untreated, these complications can lead to skin infections, permanent nerve injury, and even tissue death. They can be avoided by replacing the cast if it gets damaged or is too tight.

You can have fun with your cast, but, for many people, they eventually become extremely annoying and even unbearable. No matter how annoying they become, never attempt to remove a cast on your own. This is true even if a cast is scheduled to be removed.

Orthopedists remove casts with saws specially designed to avoid harming underlying tissues. Attempting to remove a cast with other tools can be dangerous and cause serious injury. If you feel that your cast needs to be removed for any reason, call your healthcare provider.

To make yourself more comfortable, elevate the cast above your heart with pillows. Elevating the cast helps to reduce swelling and pain. You can use more pillows to prevent excessive movement of the affected limb.

The healing time for fractures varies both by the bone and the type of fracture, but the average time is about six to eight weeks.

National Library of Medicine. Closed reduction of a fractured bone - aftercare.

American Family Physician. Principles of Casting and Splinting.

National Library of Medicine. Pressure Sores.

American Academy of Orthopaedic Surgeons. Compartment Syndrome.

By Jonathan Cluett, MD Jonathan Cluett, MD, is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams.

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