Which cast is used for fracture of the wrist and finger with open wound, swelling and infection?

• A. Shoulder Spica Cast
• B. Short Arm Circular Cast
• C. Munster/Fuenster Cast
• D. Short Arm Posterior Mold

Answer: (D)

When swelling or an open wound is present, immobilization should protect the fracture without squeezing the soft tissues. A noncircumferential approach that allows access to the wound and room for edema to expand is ideal. A short arm posterior mold does just that: it stabilizes the wrist and fingers while resting mainly on the back of the forearm, leaving the front open for wound inspection and dressing changes. This design reduces the risk of pressure on the wound and skin, lowers the chance of pressure-related complications, and can be adjusted or removed as swelling subsides. As swelling decreases, the immobilization can be modified or converted to a definitive cast.

In contrast, a fully circular short arm cast encircles the forearm and wrist, which can compress swollen tissues and complicate wound care. A shoulder spica cast addresses a different injury region altogether, making it inappropriate for wrist and finger fractures. The Munster/Fuenster cast is another circumferential option that would similarly constrain swelling and wound management, which is not desirable in this scenario.