Advanced Working demonstrated a case where a patient could be treated without surgery when the circumstances were such, that an improvement in the traumatic condition of the patient could take place and it would be to their clinical benefit.
Occasions which present the opportunity for clinical interventions by the cast technician may also hold the possibility that the clinical situation will not be improved by the application of a cast. The image below depicts just such a case.
The red lines describe an 11 degree angle between the tibial plafond and the talar dome. There is a fracture through the medial malleolus and the distal fibula has sustained an oblique fracture at the level of the ankle joint and above (Danis-Weber B) so the fracture is highly unstable.
My reaction on being asked to cast this injury in a full lightweight cast just two days post trauma was to refuse. Refusal documents a similar set of circumstances.
The improvements which we can make to this situation with a cast are minimal. Surgery is the appropriate option in this case and the clinical value of a cast technician attempting to correct this injury is very limited.