Reduction must be maintained during cast application by gentle manual and/or gravity traction.
Abundant cast padding is applied. This should not be too tight but may include very gentle compression.
Progressive local soft-tissue swelling is expected during the first days after injury. Therefore, a closed circular cast is usually contraindicated. The cast may be split and spread anteriorly, or “bivalved” with medial and lateral cuts. The splitting should provide room for swelling, the padding should not be too tight, and all bony prominences should be decompressed.
Plaster of Paris or fiberglass cast tape can be used. With plaster, the cast must be allowed to harden before splitting is possible.
A compartment syndrome can occur even after a cast is split. The split cast has to be sufficiently stable to support the fracture.