The Multidimensional Impact of Traditional Orthopaedic Casting and the Role of Emerging Immobilization Technologies: A Narrative Review.

backgroundTraditional orthopaedic casting has remained the cornerstone of non-surgical fracture management for more than a century. Although plaster and fiberglass casts reliably stabilize fractures, they are associated with physical, psychological, emotional, social, and economic burdens that extend beyond bone healing. Children, older adults, and individuals with pre-existing vulnerabilities may be disproportionately affected. Despite increasing recognition of these complications, existing orthopaedic literature has historically prioritized radiographic healing and biomechanical stability, with limited synthesis of the broader multidimensional patient impact of traditional casting. Emerging technologies such as light-cured polymer mesh (LCPM) systems and 3D-printed lattice immobilizers have been developed to address these limitations and better align fracture care with patient-centered principles.

methodsA narrative review was conducted using a structured and transparent literature identification approach informed by PRISMA reporting principles; however, this study was not conducted as a formal systematic review and did not include risk-of-bias assessment or quantitative synthesis. A broad search of PubMed, Scopus, Web of Science, and Google Scholar was performed for studies published between January 2000 and July 2025. Search strategies combined MeSH terms and free-text keywords relating to orthopaedic casting, complications, psychosocial impacts, LCPM, and 3D-printed immobilizers. Following duplicate removal and a structured review process, 87 studies were included in the final narrative synthesis. Eligible studies included randomized controlled trials, observational studies, qualitative research, case series, and systematic reviews. Data were synthesized narratively across five domains: physical, psychological, emotional/social, economic, and technological alternatives.

resultsTraditional plaster and fiberglass casts were consistently associated with musculoskeletal deterioration, joint stiffness, dermatological complications, and hygiene challenges. Psychological and emotional consequences included cast-induced anxiety, claustrophobia, depressive symptoms, and diminished autonomy. Social participation was frequently reduced due to mobility restrictions and perceived stigma, while economic impacts included hidden out-of-pocket expenses, caregiver burden, lost wages, and disparities in access to follow-up care. In contrast, emerging alternatives demonstrated promising advantages. LCPM systems improved ventilation, comfort, and hygiene, while reducing saw-related anxiety. Preliminary evidence suggests that both LCPM and 3D-printed systems may support improved patient experience and earlier return to selected activities, although larger comparative studies are needed to confirm effects on complication rates and long-term outcomes. Over time, these benefits may help offset higher upfront material costs.

conclusionsFracture care should be evaluated not only by radiographic healing but also by patient-centered outcomes such as comfort, independence, and quality of life. Traditional casting imposes significant multidimensional burdens, whereas newer technologies such as LCPM and 3D-printed systems may offer a more holistic approach to immobilization while maintaining acceptable fracture stability in appropriately selected patient populations. While current evidence indicates potential physical, psychological, and economic advantages, large-scale comparative trials remain necessary to confirm long-term clinical, psychosocial, and cost-effectiveness outcomes across diverse populations. Future integration of emerging immobilization technologies into clinical practice may support more patient-centered, function-oriented, and cost-conscious approaches to fracture care.