Cast Application Techniques for Common Pediatric Injuries

A Review

Karim Sabeh, MD; Amiethab Aiyer, MD; Spencer Summers, MD; William Hennrikus, MD


Curr Orthop Pract. 2020;31(3):277-287. 

In This Article

Cast Removal Technique and Complications

An electric oscillating cast saw is used to remove a cast. The oscillating saw can burn or cut the skin. The operator should plan the cast removal with cuts that avoid bony prominences. The operator should also utilize the thumb or index finger to apply counterforce to avoid plunging (Figure 11). The cast saw is used with an "in and out" motion. Never drag the blade through the cast as this negates the oscillating function of the saw and can cause skin injuries.

Figure 11.

(A) Supplies needed for cast removal. (B) Cast removal. The operator should also utilize the thumb or index finger to apply counterforce to avoid plunging.

The use of an oscillating saw can also cause iatrogenic burns and abrasions from the heat generated by frictional forces and direct blade contact. Shuler and Grisafi[27] performed a cadaver study and found that the highest skin temperatures were recorded for fiberglass casts with two layers of padding. While the lowest skin temperatures were with plaster casts and four layers of padding.

Another commonly used technique to shield the skin during cast removal is using a Zip stick. The Zip stick is a convenient cast removal aid that can offer additional patient protection by sliding under the cast providing a smooth path for the cast saw or scissors (Figure 12). One can also use a towel soaked with water to cool the blade down frequently during cast cutting to reduce the risk of iatrogenic skin burns.[28] In general, cast saw blades should be replaced on a regular basis approximately every 4 mo.

Figure 12.

(A through C) Removing a cast with cast saw and Zip stick to protect the skin.