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Cast wedging is used when the broken bones are set inside a cast but do not stay in good alignment. The fractured ends of the bones move away from each other. This is called a loss of reduction. Unless it is corrected, the limb will heal with a deformity.
If the cast is a good fit, it may not be necessary to remove it and reset the bones. An X-ray of the arm can be taken. The angle of the malaligned arm is traced from the X-ray. The tracing is transferred to the cast to show the position of the angled fractures.
Now the plaster is cut nearly all the way around the arm at the apex of the deformity. A small bridge of plaster is left at the apex. Wedges made of cast material or cork are applied opposite this bridge. Enough wedging is used to bring the line drawn on the cast straight.
Another X-ray is taken to confirm the correct position of the bones. The cast is reinforced in this position. If this method does not realign the bones, then surgery may be needed to make the necessary reduction.
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