Novel Method may reduce Complications of Cast Removal with Oscillating Saws

Several methods have been used to remove circular casts. Initially, a sharp knife was used, and then scissors and plaster shears were used. Plaster-of-Paris casts were removed by soaking them in water or a water/vinegar solution and then unrolling them. In 1943, Dr. Homer Stryker invented an electrically powered oscillating saw to remove the cast. Despite the saw design, iatrogenic cast-saw injuries are not rare.

Adnan Sevencan conducted a study to evaluate the complications associated with conventional methods of cast removal and to compare them with the complications associated with a novel method involving the use of externally guided aids for skin protection. The study was performed at Eskisxehir Osmangazi University Hospital, Eskisxehir, Turkey. This study has been published in “The Journal of Bone and Joint Surgery.”

Two hundred and eight cooperative patients more than 5 years of age who had no experience with cast removal were included in the study. Patients were selected arbitrarily and were divided into 2 groups.

In Group 1 (106 patients [115 casts]; 60% male; average age, 20 years), conventional protection methods were used.

In Group 2 (102 patients [108 casts]; 62% male; average age, 26 years), tong-shaped, externally guided, steel plate aids were used for skin protection.

After the insertion of the protective part between the skin and the cast materials, the outer portion of the aid guided the operator to stay in a safe cutting line. The cast removal procedures in each group were documented, and skin injuries, burns, patient anxiety, operator anxiety, and processing time were noted.

Key findings of the study:

• In Group 1, the skin mark/scratch rate was 18%, the full-thickness skin laceration rate was 0.9%, the burn sensation rate was 22%, and the rate of first/second-degree burns was 2.5%. Anxiety was classified as moderate by 57% of the patients and as severe by 8%. Moderate anxiety was reported by 20% of the cast operators.

• In Group 2, only 6% of the patients experienced moderate anxiety and the removal time was reduced by >25%.

• When the groups were compared with regard to severe complications such as skin laceration (resulting in bleeding), visible burn, and severe anxiety, the former 2 complications were eliminated in Group 2 but the difference between the groups was statistically significant in the last category only (p = 0.325, p = 0.247, p = 0.007, respectively).

The authors concluded that – “Cast removal complications are not uncommon and are not limited to objective injuries. Subjective complications are more common but are mostly ignored. The novel method described in the present study eliminates 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.”

Level of Evidence: Therapeutic Level IV.

Further reading:

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

Adnan Sevencan

J Bone Joint Surg Am. 2023;105:35-41

http://dx.doi.org/10.2106/JBJS.21.01556