How to Avoid Cast Saw Complications

  title={How to Avoid Cast Saw Complications},
  author={Matthew A. Halanski},
  journal={Journal of Pediatric Orthopaedics},
  • M. Halanski
  • Published 1 June 2016
  • Medicine
  • Journal of Pediatric Orthopaedics
Background: As casts are routinely used in pediatric orthopaedics, casts saws are commonly used to remove such casts. Despite being a viewed as the “conservative” and therefore often assumed safest treatment modality, complications associated with the use of casts and cast saws occur. Methods: In this manuscript, we review the risk factors associated with cast saw injuries. Results: Cast saw injuries are thermal or abrasive (or both) in nature. Thermal risk factors include: cast saw… 

Establishing Safety Parameters for Orthopaedic Cast Saw Blade Usage

When a Stryker 940 cast saw without vacuum is used to cut plaster casts, the ion-nitride blade should be changed frequently, at minimum after 60 casts have been split, or 30 casts has been bivalved.

Having Patience With Our Patients: A Key Technique in Cast Saw Burn Prevention

A minimum of 7 minutes of set time for a fiberglass cast before attempting to bivalve using segmented cuts is associated with the smallest increase in temperature of the saw blade.

Cast Saw Burn Prevention: An Evidence-Based Review.

A review of currently published data provides clinicians with a summary of the literature to guide practice based on the best available evidence, with the goal of preventing iatrogenic cast saw burns.

Current Complications of Cast Removal with Oscillating Saws and a Novel Method for Reducing Such Complications: A Comparative Clinical Study.

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Eliminating saw blade-to-skin contact with a tong-like, externally guided flexible steel aid provides a high level of safety, decreases removal time by 5 to 10 minutes (depending on cast length), and makes cast removal a better experience for both patients and operators.

Neuromuscular Patients Are 40% More Likely to Get a Cast Injury

The incidence of cast injuries is 12.5 per 1000 children at the authors' level I trauma tertiary referral pediatric clinic and patients with neuromuscular disorders are at significantly higher risk for experiencing cast injuries.

Alternatives to Traditional Cast Immobilization in Pediatric Patients.

The disadvantages of traditional casting can be minimized by alternative management strategies: waterproof casts to facilitate bathing and swimming; a Pavlik harness in infants, a single- leg spica cast, or flexible intramedullary nails to avoid complications with double-leg spica casts for femur fractures.

A Comparison of Casting Versus Splinting for Nonoperative Treatment of Pediatric Phalangeal Neck Fractures

A retrospective study of patients aged 18 and below with phalangeal neck fractures treated nonoperatively from 2008 to 2017 finds no significant difference in clinical and radiologic outcomes between children who were treated in casts and those treated in removable splints.

Ponseti Cast Removal: Video Technique

Cast soakage with lukewarm water followed by unwrapping is a simple and cost-effective method of Ponseti cast removal which can be done by parents at home improving the overall satisfaction of the family.

Novel Cast-saw Alarm System Reduces Blade-to-Skin Contact in a Pediatric Upper Extremity Model

Blade-to-skin contact can be reduced with the use of a cast-saw alarm, however, alarm use significantly reduced the number of touches of >0.5 seconds duration in users with little prior cast- Saw experience.



Cast Saw Burns: Evaluation of Simple Techniques for Reducing the Risk of Thermal Injury

This study suggests that the routine use of any of these 3 methods would significantly decrease the risk of patient discomfort and thermal injury during cast cutting, and provides simple method for decreasing risk of thermal injury when removing casts.

Cast-Saw Injuries: Assessing Blade-to-Skin Contact During Cast Removal: Does Experience or Education Matter?

In a limited sample size, experience and education did not prevent this; therefore, minimizing time of contact and blade temperature may be more important factors in minimizing cast-saw injuries.

Cast-saw burns: evaluation of skin, cast, and blade temperatures generated during cast removal.

A poor removal technique, fiberglass casting material, and thinner cast padding resulted in significantly higher skin temperatures, and four layers of cast padding compared with two layers significantly reduced skin temperatures for both plaster and fiberglass casts.

Cast-saw burns: comparison of technique versus material versus saws.

The results demonstrated that cast-saw blades manufactured with stainless steel are poorly suited for a device that uses friction to separate a cast.

Thermal injury with contemporary cast-application techniques and methods to circumvent morbidity.

Excessively thick plaster and a dip-water temperature of >24 degrees C should be avoided and overwrapping of plaster in fiberglass should be delayed until the plaster is fully cured and cooled.

Cast and Splint Immobilization: Complications

Casting is not without risks and complications (eg, stiffness, pressure sores, compartment syndrome); the risk of morbidity is higher when casts are applied by less experienced practitioners.

Oscillating saw injuries during removal of plaster

Strict protocols were required and have been introduced at the Alexandra Hospital to avoid litigation and the identified cause of injury was the removal of a plaster cast by an inexperienced, ill-trained user or blunt saw blade.

Epidemiology and prevention of cast saw injuries: results of a quality improvement program at a single institution.

The rate of cast saw injuries in a busy pediatric orthopaedic department was small, but a considerably increased risk existed for those patients cared for in the emergency department by orthopedic residents, and improving education and training in cast saw use has the potential to decrease the prevalence ofCast saw injuries over time.

Setting temperatures of plaster casts. The influence of technical variables.

It was found that if the temperature of the dip water was higher than 24 degrees Celsius or the thickness of the cast was greater than eight ply, or both, and if the pillow was used to limit the dissipation of heat from the cast, temperatures high enough to cause skin burns could occasionally be reached.

Development of a cast application simulator and evaluation of objective measures of performance.

This casting simulation model and evaluation instrument is a reliable assessment of casting skill in applying a short arm cast and further work is needed to establish construct validity.