July 13, 2025, 3:08 pm | Read time: 4 minutes

A fracture that requires a cast usually happens suddenly–and regardless of whether you have already booked a trip. If you’ve never been in this situation, you might not realize that such an injury can disrupt travel plans. The person affected may not be “Fit to Fly.”

Flying with a Cast Requires a “Fit to Fly” Certificate

In other words, if you want to fly with a cast, you definitely need a so-called flight fitness certificate–also known as a “Fit to Fly” certificate. Airlines usually provide a form for this purpose. The attending physician must fill it out and sign it, taking responsibility for declaring that the person is “medically fit to fly”–as stated in a form from Thai Airways.

You may have already heard of a “Fit to Fly” certificate. Such a document is required for passengers with various medical conditions (such as respiratory issues), when they need to carry medical devices, or for expectant mothers traveling after the 28th week of pregnancy. However, this is specifically about flying with a cast. And by the way, obtaining the certificate is not guaranteed.

Fresh Fracture? When a Cast Can Be Dangerous

There are several scenarios where a flight fitness certificate cannot be issued for a fracture or cast–or at least special caution is advised. In the first 48 hours after a fracture, there is an increased risk of swelling in the affected area. Flying during this early phase can be problematic because cabin pressure at altitude can exacerbate swelling. To allow the tissue space to expand, a fresh cast must be split lengthwise. Without this measure, there is a risk of severe circulation issues. In the worst case, a condition known as compartment syndrome can occur–an increase in pressure within the muscle that can interrupt blood supply and cause permanent damage.

Also interesting: Do Certain “Standard” Airplane Seats Offer More Legroom?

Concealing a fracture and hiding the cast under a sleeve during boarding would not be a good idea. Serious health consequences could ensue. Passengers are required to inform the airline of their health condition. In many cases, organizational arrangements are necessary. For example, a person with a fully casted leg would need to book three seats, according to Ryanair.

Complex or Unstable Fractures Make Flying Risky

Open fractures, where the bone protrudes through the skin, and unstable fractures that require stabilization with an external fixator are considered particularly risky. Even boarding and deplaning can be problematic with these injuries. Turbulence can jeopardize the stability of the fixator and potentially lead to further complications.

Patients with an increased risk of thrombosis, such as from a recent leg fracture and limited mobility, should not participate in a regular commercial flight, according to medical experts. Prolonged sitting in a cramped position increases their risk of deep vein thrombosis or even a life-threatening pulmonary embolism.

More on the topic

Flying While Pregnant What Pregnant Travelers Need to Know About Flying

Did you know that? Why dying during a flight is often not technically possible

Exciting questions and answers What you definitely didn’t know about airplanes

What Do Injured People Do Who Can’t Fly?

People with severe but stable injuries may receive a medically accompanied transport on a commercial flight with special arrangements, such as a lying position. However, this must be coordinated with the airline well in advance and is logistically demanding.

In most cases–and if the distance allows–a ground-based return transport is used, such as with an ambulance or an intensive care transport vehicle. Depending on the case and coverage (e.g., through travel health insurance), an air ambulance with a specially equipped aircraft may also be possible.

* TRAVELBOOK was advised by a senior physician in orthopedics, trauma surgery, and sports medicine.