Cast Saw Burn Prevention: An Evidence-Based Review

Larson, Jill E.; Nicolay, Richard W.

doi:10.5435/jaaos-d-20-00723

Cited by 4 publications

(7 citation statements)

References 39 publications

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“…They're also associated with litigation fees which average $15,898 per patient. 6,9,28 Therefore, increased awareness, training, and innovation are required to further reduce their incidence. The technique proposed theoretically reduces the cast saw's use in half by only perforating one side of the cast (univalve rather than the standard bivalve), therefore also reducing risk of injury by 50%.…”

Section: Discussionmentioning

confidence: 99%

“…The concave side is deeper, less accessible, and therefore more prone to injury (Figure 2). 6 The convex side is more accessible to the cast saw. By fully cutting the plaster down to cotton on the convex side of the cast with our technique, the concave portion of the cast, which is at higher risk of injury, is avoided.…”

Section: Description Of the Methodsmentioning

confidence: 99%

“…By fully cutting the plaster down to cotton on the convex side of the cast with our technique, the concave portion of the cast, which is at higher risk of injury, is avoided. 6 The child should be turned during the procedure so the cast portion being cut is facing upward. Studies have shown that with the patient in the lateral decubitus position, the lateral portion of the cast sits 16.2 mm above the skin on average as opposed to 13.7 mm if the patient is positioned supine.…”

Section: Description Of the Methodsmentioning

confidence: 99%

“…Cast saw burn rates ranges from 1.3 to 7.2 burns per 1,000 casts removed. 6,7 The incidence of cast saw injuries has been recorded as high as 1.23% at a single institution. 8 The oscillating cast saw, developed by Homer Stryker, is designed to cut hard material but not flexible surfaces that move with the saw, such as skin.…”

Section: Introductionmentioning

confidence: 99%

“…Some institutions have proposed a zero-event policy. 13 Several methods have been shown to reduce the incidence of cast saw injuries, including using appropriately sharp cast saw blades, 6 intermittently inspecting the blade's temperature and cooling it with water or alcohol, 14 running the cast saw with a vacuum to clean debris and keep it cool, 15 and positioning safety strips under the cast. 16 Improving education around proper cast saw usage technique and the use of laboratory simulation has also been advocated as a means to reduce iatrogenic injuries.…”

Section: Introductionmentioning

confidence: 99%

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A Novel Technique to Remove Plaster Ponseti Clubfoot Casts

Monárrez¹,

Herzenberg²,

McClure³

2022

Journal of the Pediatric Orthopaedic Society of North America

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Serial Ponseti-style plaster of Paris casts are considered the gold standard treatment for clubfoot in infants. In conjunction with cast application, weekly cast removals are a necessary part of treatment, predisposing this patient population to cast saw injuries. Extensive research and education have been devoted to eliminating iatrogenic cast saw injuries. However, decreasing experience and familiarity with cast saws lead to a 1-2% incidence rate of cast saw burns or abrasions. While alternatives such as soaking the cast off or using protective strips are available, these lead to interruptions in clinic workflow and failure to successfully treat clubfoot, respectively. We present a technique which successfully and safely removes Ponseti-style plaster of Paris casts by perforating only the convex side of the cast, using superficial partial thickness scores, and a large cast spreader. The proposed technique can reduce cast saw injuries by potentially 50%.

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Section: Discussionmentioning

confidence: 99%

Section: Description Of the Methodsmentioning

confidence: 99%

Section: Description Of the Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

A Novel Technique to Remove Plaster Ponseti Clubfoot Casts

Monárrez¹,

Herzenberg²,

McClure³

2022

Journal of the Pediatric Orthopaedic Society of North America

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Overwrapping Bivalved Casts: Does the Material Matter?

Karkenny,

Morris,

Smith

et al. 2024

Journal of Pediatric Orthopaedics

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Background: Circumferential integrity of bivalved casts (cut twice longitudinally) can be restored by overwrapping with different materials. This study compared the mechanical properties of solid casts and bivalved casts overwrapped with semirigid fiberglass (SF), elastic bandages (EB), and rigid fiberglass (RF) using an overwrapped-bivalved cast-bone fracture (OBCBF) model. Methods: This study used an MTS Bionix Servohydraulic system to test properties of OBCBF models in 4 conditions: intact Control made of RF (not bivalved or overwrapped), a Rigid overwrapped model made of a Control bivalved and overwrapped with RF, a Semirigid overwrapped model made of a Control bivalved and overwrapped with SF, and an Elastic model made of a Control bivalved and overwrapped with EB. Constructs were tested in 4-point bending. Force-displacement curves (FDC) were generated to calculate load-at-critical-failure (LCF, angulation > 10 degrees = 6.6 mm vertical deformation) and stiffness. Results: Five controls and 30 OBCBF models with 3 overwrapped cast types were tested, with each overwrapped cast type tested with 2 orientations of the initial cast bivalve axis, yielding 7 conditions (Control, Rigid 0 degrees, Rigid 90 degrees, Semirigid 0 degrees, Semirigid 90 degrees, Elastic 0 degrees, Elastic 90 degrees). Mean LCF was: Rigid 90 degrees > Rigid 0 degrees > Control > Semirigid 0 degrees > Semirigid 90 degrees > Elastic 90 degrees > Elastic 0 degrees (P<0.0001). Mean stiffness was: Rigid 0 degrees > Rigid 90 degrees > Control > Semirigid 90 degrees > Semirigid 0 degrees > Elastic 0 degrees > Elastic 90 degrees (P<0.0001). Multiple comparisons indicated no significant difference between LCF and stiffness for Semirigid 0 degrees/90 degrees casts compared with Controls. Conclusions: Mechanical properties of overwrapped bivalved casts change depending on the materials used to overwrap, with higher LCF and stiffness when overwrapping with RF > SF > EB; however, mean comparisons indicate that rigid bivalved casts overwrapped with SF did not have significantly different mean stiffness and LCF from controls and other cast models. Clinical Relevance: This study compares the bending properties of a bivalved cast-construct overwrapped with different materials, providing basic science evidence for orthopaedic surgeons who have several choices of materials to overwrap bivalved casts.

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Cast Removal: Pearls and Methods

Miller,

Purnell

2023

Advanced Emergency Nursing Journal

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Cast removal is a common procedure that can involve risks to the patient and should be done by a qualified and experienced provider. Indications for removal, assessment parameters, and careful procedural steps should be understood by all technicians, practitioners, and physicians who will participate in the removal of casting materials. Because this procedure can also produce anxiety for the patient and their family members, it is good practice to thoroughly inform the patient and answer any questions in advance to help reduce anxiety and promote cooperation from all during the process. This article describes common techniques for cast removal and provides tips to facilitate safe and efficient outcomes during this procedure.

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Cast Saw Burn Prevention: An Evidence-Based Review

Cited by 4 publications

References 39 publications

A Novel Technique to Remove Plaster Ponseti Clubfoot Casts

A Novel Technique to Remove Plaster Ponseti Clubfoot Casts

Overwrapping Bivalved Casts: Does the Material Matter?

Cast Removal: Pearls and Methods

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