Background: The use of an oscillating saw for cast removal creates a potential for iatrogenic injury and patient discomfort. Burns and abrasions can occur from the heat created by frictional forces and direct blade contact. With use of a cadaver model system, skin temperature measurements were recorded during cast removal with an oscillating saw.
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.
Shuler, F.D., Grisafi, F. 2008. Cast saw burns: evaluation of skin, cast, and blade temperatures generated during cast removal. J Bone Joint Surgery Am. 90:2626-2630.