Plaster cast immobilisation during air travel-analysis of current practice and aircraft-simulated experimental study

SummaryBackgroundThere is an increase in aircraft transportation of patients with lower limb fractures. Current practice is variable. Our aim was to study current practice and to analyse the situation in an experimental simulated aircraft flight.MethodsCurrent advice supplied by commercial airline offices in the UK was noted. Postal questionnaires were sent to Orthopaedic Consultants in the UK to obtain their current practice. Experimental aircraft travel was simulated in a decompression chamber with five medically fit volunteers with no fracture, immobilised in an above knee plaster cast. Compartment pressure and venous return was documented and the results analysed in two different positions with the leg elevated and dependant.ResultsAirlines do not have any formal guidelines. Orthopaedic consultants in the UK note variable advise in this situation. Experimental study in the aircraft simulation showed that two volunteers developed significant increase in compartmental pressure with the leg elevated to 90°, which settled after the plaster cast was split. There was no increase in compartment pressure noted with leg dependant on the floor with 45° of flexion at hip.ConclusionThe literature on this issue is limited. With our analysis we feel that patients can be transported with the plaster cast split with limb dependant on the floor i.e. hip flexion less than 45°. Our volunteers had no fractures so direct comparison with pathological changes in acute fracture is problematical. Further studies into this problem are recommended.