Injury, Int. J. Care Injured 33 (2002) 55–56

Doctor, can I drive with this plaster? An evidence based response

Stephen Blair *, Omar Chaudhri, Alberto GregoriDepartment of Orthopaedic Surgery, Hairmyres Hospital, Eaglesham Road, East Kilbride, Lanarkshire G75 8RG, UK

Accepted 3 August 2001

Abstract

The purpose of this study is to assess the effect of the commonly used below elbow plaster casts on driving ability. The positionof the Driver and Vehicle Licensing Agency and five motor insurance companies is established. The study aims to help doctorsdecide whether or not a patient is fit to drive with a plaster cast. Three types of cast were tested using one driver. A score wasgiven for several driving abilities. The right Colles cast was found to have no effect on ability to drive. Scaphoid and Bennett’scasts were found to have significant affects on driving ability. The DVLA has no specific guidelines regarding driving with aplaster cast and the position of insurance companies is variable, but will usually depend upon medical advice. © 2002 ElsevierScience Ltd. All rights reserved.

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1. Introduction

One of the more common questions asked by anypatient that requires a plaster cast is, ‘‘Doctor, can Icontinue to drive’’. The answer may be an obvious no,but in many cases the decision is a matter of judgement.The DVLA has no specific guidelines for this situation.The position of insurance companies is variable; some willnot cover a driver with a plaster cast, others allow it ifa medical practitioner deems it safe to do so.

How does a doctor make a rational decision? Ulti-mately, this will depend on the patient, the type of plastercast and the nature of the injury. The type of vehicle mayalso be relevant; a left leg below-knee plaster is unlikelyto affect the ability to drive an automatic right-hand drivevehicle. However, driving with a cast on the right brakefoot would almost certainly affect a driver’s ability tobrake safely. The effect of a below elbow cast is less clear.

2. Method and materials

We assessed driving ability with three types of casts:1. Colles cast: a below elbow cast, leaving the thumb

and fingers free, was used. The wrist was flexed to20°.

2. Scaphoid cast: a below elbow cast, with the thumbimmobilised up to the interphalangeal joint.

3. Bennett’s cast: a below elbow cast, with the thumbimmobilised in extension.

Both left and right casts were used for each type. Thedriving abilities tested were: gear changing, steering,reversing, hand brake control, indicator/horn controland around town driving. The vehicle used was amanual geared right-hand drive Ford Mondeo withpower steering. A lightweight cast was applied and thevehicle driven around town. Each of the driving abili-ties was tested and scored out of three: 3 points for nolimitation of control, 2 points for some limitation ofcontrol and 1 point for significant limitation of control.The vehicle driver performed these assessments. As anexperienced clinician and car driver, the vehicle driverpossessed the necessary skills and judgement to assesseach driving ability. The same driver was used for allthe tests. We also asked ten motor insurance companiesfor their opinion on driving with casts. The position ofthe DVLA was established from the Drivers MedicalUnit.

3. Results

A total score out of 18 was given for each of the sixcasts tested. A summary of the results is outlined inTable 1.

* Corresponding author. Present address: 55 Burnopfield Road,Rowlands Gill, Tyne and Wear NE39 1QQ, UK. Tel.: +44-1355-220-292; fax: +44-1355-234-064.

E-mail address: blair–stephen@hotmail.com (S. Blair).

0020-1383/02/$ - see front matter © 2002 Elsevier Science Ltd. All rights reserved.PII: S 0 0 2 0 -1383 (01 )00141 -3

S. Blair et al. / Injury, Int. J. Care Injured 33 (2002) 55–5656

Table 1Summary of results

Gear change Indicator/horn ReverseSteering Hand-brake Around town Total score

3 3 33 2Colles (left) 3 173Colles (right) 3 3 3 3 3 18

Scaphoid (left) 22 2 3 2 2 133 3 32 3Scaphoid (right) 2 16

2Bennett’s (left) 1 2 3 2 2 12Bennett’s (right) 2 3 3 3 3 2 16

The left Bennett’s cast was found to have the greatestlimitation on driving ability. The right Colles cast wasfound to have no effect on ability to drive.

Five replies were received from motor insurance com-panies. Two companies advised against driving with aplaster cast. The other three permitted a driver to drivewith a cast if a medical practitioner advised it safe to doso. One company had no duty of disclosure under thesecircumstances.

4. Discussion

Although the DVLA has no specific guidelines, theiradvice for driving after surgery is relevant [1]. Thedistracting effect of pain, impairment due to analgesiaand any physical restrictions should be considered. It isalso the responsibility of the driver to ensure that he isin control of the vehicle at all times and if stopped bythe police he must be able to demonstrate this. Theabove test was performed in the absence of pain oranalgesics and therefore, does not simulate the acutesituation. Obviously, these factors need to be consid-ered when deciding if a patient is fit to drive. TheDVLA also state that driving after surgery should bediscussed with the doctor concerned.

The patient with a cast will certainly not be able todrive if their insurance company does not advise it.Some insurers will continue insurance cover for a driverwith a cast provided that a medical advisor deems itsafe to do so.

If the insurance company allows the patient to drive,then the doctor concerned will have to make the finaldecision after discussion with the patient. With varyingdegrees of incapacity and numerous types of vehicles, itis difficult to set guidelines and each case requiresindividual consideration.

In our study, the right-hand Colles cast has nolimitation on driving ability provided that there are noother relevant factors. The scoring system is subjectiveand depends upon the judgement of the driver. In theacute situation, the patient is likely to have pain andrequire analgesics. This will certainly further affectcontrol of the vehicle. It would seem wise to wait untilthe pain subsides before advising a patient that he candrive.

Another factor is power steering; a large car withoutpower steering may be difficult to steer with a cast. Thedegree of flexion at the wrist will alter the power of thegrip; a wrist in a high angle of flexion is likely to affectdriving ability.

In our study, the left Colles cast scored 17 points.This was due to handbrake operation. In the vehicleused, the clearance around the handbrake was narrowmaking it slightly awkward to engage. If there wereadequate clearance, then this cast would have had nolimitation on control of the vehicle.

The Scaphoid and Bennett’s casts significantly af-fected control and driving with these casts would seemunwise.

5. Conclusions

Provided that a driver’s insurance company is inagreement, the driver’s doctor may be asked to makethe judgement on ability to drive safely. Importantother factors to consider are pain, analgesics, type ofcast and type of vehicle, as well as power steering andadequate clearance for the affected arm.

The right Colles cast is unlikely to affect drivingcontrol in most cases. The left Colles cast has no effectif hand brake clearance is adequate. Scaphoid andBennett’s type casts have significant effects on drivingcontrol.

Many factors need to be considered and each caserequires individual assessment. With careful appraisal,doctors should now be able to make an evidence baseddecision to advise a patient on their fitness to drive witha below elbow cast.

Acknowledgements

We would like to thank the staff of Hairmyres Hos-pital fracture clinic for their assistance.

References

[1] Driver and Vehicle Licensing Agency. At a Glance Guide to theCurrent Medical Standards of Fitness to Drive. March, 2000(www.open.gov.uk/dvla.htm).