How often should I ice a casted fracture?

How Often to Ice a Casted Fracture

Apply ice to a casted fracture for 10-20 minute periods, repeated 3-4 times daily during the first few days after injury, with particular benefit demonstrated at 3 and 5 days post-injury. 1, 2

Optimal Icing Protocol

Duration and Frequency

• Limit each ice application to 20 minutes maximum to prevent cold injury and tissue damage 1
• If 20 minutes causes discomfort, 10-minute applications are equally effective and represent a reasonable alternative 1, 3
• Repeat applications 3-4 times per day during the acute phase (first 24-72 hours) 4
• Continue icing at days 3 and 5 post-injury for optimal symptomatic relief in fracture management 1, 2

Application Method

• Use a mixture of ice and water in a plastic bag or damp cloth, which is superior to ice alone or refreezable gel packs for effective tissue cooling 1
• Always place a thin towel barrier between the ice pack and cast/skin to prevent cold injury 1
• The ice-water mixture is more effective at lowering tissue temperature than ice cubes alone 1

Clinical Rationale

Why Ice Works for Fractures

• Cryotherapy reduces hemorrhage, edema, pain, and disability in musculoskeletal injuries including fractures 1
• Ice application is particularly effective during the first 24 hours after injury when inflammatory response is most active 1, 4
• Evidence demonstrates benefit specifically at 3 and 5 days post-fracture for pain control 1, 2

Evidence Quality Considerations

The American Heart Association and American Red Cross guidelines provide the strongest recommendations for ice application protocols 1, while the American Academy of Orthopaedic Surgeons specifically validates ice use at days 3 and 5 for distal radius fractures 1, 2. However, systematic reviews note that while ice effectively reduces pain, the overall quality of evidence for specific protocols remains limited 5.

Important Caveats

Safety Precautions

• Never apply ice directly to skin or cast without a barrier 1
• Stop immediately if numbness, tingling, or skin color changes occur 1
• Avoid continuous ice application beyond 20 minutes as this increases risk of cold injury 1, 3

When Ice May Be Less Helpful

• After the acute inflammatory phase (beyond 5-7 days), continued aggressive icing provides diminishing returns 1, 4
• Ice application can impair motor function for up to 30 minutes post-treatment, though this is less relevant with a casted extremity 3

Practical Algorithm

Days 0-3 (Acute Phase):

• Ice for 20 minutes (or 10 minutes if uncomfortable)
• Repeat 3-4 times daily
• Use ice-water mixture with towel barrier 1, 4

Days 3-5 (Subacute Phase):

• Continue icing 2-3 times daily
• Particularly important at days 3 and 5 for fracture-specific pain relief 1, 2

Beyond Day 5:

• Ice as needed for pain control
• Frequency can be reduced to 1-2 times daily or as symptoms dictate 1