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Cast-Saw Burns: Evaluation of Skin, Cast, and Blade Temperatures Generated During Cast Removal

¹ Department of Orthopaedics, West Virginia University, P.O. Box 9196 Health Sciences Center, Morgantown, WV 26506-9196. E-mail address for F.N. Grisafi: fgrisafi{at}hsc.wvu.edu

Investigation performed at the Department of Orthopaedics, West Virginia University, Morgantown, West Virginia

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants of less than $10,000 from Albert B. Ferguson, M.D. Orthopaedic Fund (University of Pittsburgh). Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Methods: Casts of uniform thickness were applied to cadavers equilibrated to body temperature. The casts were removed by a single individual while simultaneously measuring temperatures at the skin-padding interface, cast-padding interface, and the blade. Variables tested include two removal techniques, two casting materials (fiberglass and plaster), and two cast-padding thicknesses.

Results: A poor removal technique (the cast saw blade never leaving the cast material during cutting), fiberglass casting material, and thinner cast padding resulted in significantly higher skin temperatures. The poor technique increased skin temperatures by an average of 5.0°C (p < 0.05). Fiberglass casting materials increased skin temperatures by an average of 7.4°C (p < 0.05). Four layers of cast padding compared with two layers decreased skin temperatures by 8.0°C (p < 0.05).

Conclusions: The highest skin temperatures were recorded for fiberglass casts with two layers of padding. The lowest skin temperatures were recorded for plaster casts with four layers of padding. Four layers of cast padding compared with two layers significantly reduced skin temperatures for both plaster and fiberglass casts.

Clinical Relevance: A routine assessment of the layers of padding and the type of cast material prior to splitting casts with an oscillating saw can help clinicians to identify cast removal conditions with a higher risk for causing patient discomfort, abrasions, or burns.

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