Cast saw injuries occur during the removal of the cast after the cast has fulfilled its function on the body. These injuries differ according to the area where the cast is applied, the knowledge and experience level of the operator and the type of instruments used.
The cast saw was invented by Robert Stryker in 1945 to help operators to remove the cast from the patient safely and fast. (www.google.com/patents/US2427580). With this principle, cast saws are designed not to cut soft tissue while application. (The author demonstrating how relaxed soft tissue can oscillate with the saw blade preventing injury. Matthew A. Halanski, MD, http://links.lww.com/BPO/A58)
Despite this design, although rare, such injuries are sometimes encountered. Iatrogenic cast saw injuries occur with an incidence of 0.1% to 0.72%. (Ansari MZ, Swarup S, Ghani R, et al, 1998)
There are couple of factors that cause an injury. When these factors are eliminated or minimized, patients are going to have less injury.
Thermal injury happens if the operator does not monitor the temperature of the saw blade. For a cool operation, the operator should follow and monitor both saw blade and the casting material.
If the cast padding is unsufficient and the operator does not pay attention to how much cast padding is used, this kind of injuries occur on sensitive tissues and thin skins. This is also related to the hardness or softness of the material.
There are various discussions in the academic community about the human factor. While some studies claim that the operator’s training and experience plays an important role in injuries, some studies shows that neither training nor experience brings success.
In order to minimize the time the blade is in contact with the skin, using in-out technique is recommended. With this technique, Cast saw is pushed into one area and pulled out back. In the meantime, it is decided to which area the saw will be driven. Thus, this way the saw gets the time it needs to cool down. By pushing down and pulling out the saw blade (using the in-out technique), the skin under the cast may pushed down but not “dragged,” with the blade.
Using a dull blade and unnecessary thick material is also helping increase the heat. If these temperature changes are not monitored often, this may cause a thermal injury. Therefore, choosing the right cast cutter blade and its material is essential.
In patients burned by cast saws, thermal injuries are the result of both the absolute temperature as well as the duration of the exposure to the blade. Cooling the blade with distilled water or irrigation solution is going the decrease the temperature.
Cast removal, although it seems like a routine practice, requires great attention. All factors must be considered as a potential risk. Operators must be trained well, right cast cutter blade must be chosen and right technique must be implemented.
Click here to learn how to choose a right blade.
1. Ansari MZ, Swarup S, Ghani R, et al. Oscillating saw injuries during removal of plaster. Eur J Emerg Mede. 1998;5:37–39.
2. Henriques FC, Moritz AR. Studies of thermal injury: I. The conduction of heat to and through skin and the temperatures attained therein. A theoretical and an experimental investigation. Am J Pathol. 1947;23:530–549
3. Moritz AR, Henriques FC. Studies of thermal injury: II. The relative importance of time and surface temperature in the causation of cutaneous burns. Am J Pathol. 1947;23:695–720.
4. Williamson C, Scholtz JR. Time-temperature relationships in thermal blister formation. J Investig Dermatol. 1949;12:41–47
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