Thermal Injury with Contemporary Cast-Application Techniques and Methods to Circumvent Morbidity

Halanski, Matthew A.; Halanski, Amy D.; Oza, Ashish; Vanderby, Ray; Munoz, Alejandro; Noonan, Kenneth J.
November 2007
Journal of Bone & Joint Surgery, American Volume;Nov2007, Vol. 89-A Issue 11, p2369
Academic Journal
Background: Thermal injuries caused by application of casts continue to occur despite the development of newer cast materials. We studied the risk of these injuries with contemporary methods of immobilization. Methods: Using cylindrical and L-shaped limb models, we recorded the internal and external temperature changes that occurred during cast application. Variables that we assessed included the thickness of the cast or splint, dip-water temperature, limb diameter and shape, cast type (plaster, fiberglass, or composite), padding type, and placement of the curing cast on a pillow. These data were then plotted on known time-versus-temperature graphs to assess the potential for thermal injury. Results: The external temperature of the plaster casts was an average (and standard deviation) of 2.7° ± 1.9°C cooler than the internal temperature. The external temperature of twenty-four-ply casts peaked at an average of 84 ± 42 seconds prior to the peak in the internal temperature. The average difference between the internal and external temperatures of the thicker (twenty-four-ply) casts (4.9° ± 1.3°C) was significantly larger than that of the thinner (six and twelve-ply) casts (1.5° ± 1°C) (p < 0.05). Use of dip water with a temperature of <24°C avoided cast temperatures that can cause thermal injury regardless of the thickness of the plaster cast. A dip-water temperature of 50°C combined with a twenty-four-ply cast thickness consistently yielded temperatures high enough to cause burns. Use of splinting material that was folded back on itself was associated with a significant risk of thermal injury. Likewise, placing a cast on a pillow during curing resulted in temperatures in the area of pillow contact that were high enough to cause thermal damage, as did overwrapping of a curing plaster cast with fiberglass. Attempts to decrease internal temperatures with the application of isopropyl alcohol to the exterior of the cast did not decrease the risk of thermal injury. Conclusions: Excessively thick plaster and a dip-water temperature of >24°C should be avoided. Splints should be cut to a proper length and not folded over. Placing the limb on a pillow during the curing process puts the limb at risk. Overwrapping of plaster in fiberglass should be delayed until the plaster is fully cured and cooled.


Related Articles

  • Cast Away.  // Current Health 1;Nov2006, Vol. 30 Issue 3, p4 

    This article focuses on the advantages of the Velcro splint over orthopedic plaster casts.

  • Splint equal to cast for wrist buckle fracture in children.  // Journal of Family Practice;Jun2006, Vol. 55 Issue 6, p476 

    The article examines whether children with wrist buckle fractures have better physical functioning when treated with a removable splint than with a short arm cast. Cast immobilization seems to be the preferred method of treatment in North America, while splints are more commonly used in Great...

  • The use of external fixators in the immobilization of pediatric fractures. Norman, D.; Peskin, B.; Ehrenraich, A.; Rosenberg, N.; Bar-Joseph, G.; Bialik, V. // Archives of Orthopaedic & Trauma Surgery;Jul2002, Vol. 122 Issue 7, p379 

    The use of external fixation in the immobilization of diaphyseal and metaphyseal fractures in children is still controversial, as these fractures are generally managed by immediate plaster casting, by traction followed by casting, by various methods of internal fixation, including the recently...

  • Casting: U-slabs. Drozd, Mary; Miles, Sue; Davies, Jenny // Emergency Nurse;Oct2009, Vol. 17 Issue 6, p20 

    This article continues a short series of articles on how to apply casts. It examines how U-slabs should be applied following fracture of the shaft of the humerus.

  • Cast versus splint in children with minimally angulated fractures of the distal radius: a randomized controlled trial. Boutis, Kathy; Willan, Andrew; Babyn, Paul; Goeree, Ron; Howard, Andrew // CMAJ: Canadian Medical Association Journal;10/5/2010, Vol. 182 Issue 14, p1507 

    Background: Minimally angulated fractures of the distal radius are common in children and have excellent outcomes. We conducted a randomized controlled trial to determine whether the use of a prefabricated splint is as effective as a cast in the recovery of physical function. Methods: We...

  • The occasional short-leg cast. Brock, Gordon // Canadian Journal of Rural Medicine;Winter2001, Vol. 6 Issue 1, p48 

    Presents procedure on the application of cast to ankle or foot injuries. Materials needed for the procedure; Directions for the application of cast padding; Importance of supporting the cast against the chest.

  • Casting and Splinting.  // American Family Physician;1/1/2009, Vol. 79 Issue 1, p1 

    The article offers information about casting and splinting. It describes casts and splints as well as what are they made of and compares the difference between the two. It states that a splint usually stays on for several days to weeks but in case of a cast, the doctor will tell the patient how...

  • Is splinting of distal radius torus fractures an acceptable alternative to casting? Walker, J. Kendall; Kane, Kevin Y. // Journal of Family Practice;Apr2002, Vol. 51 Issue 4, p382 

    The article discusses research being done on the use of splinting of distal radius torus fractures as an acceptable alternative to casting. It references the study by J. S. Davidson et al published in the 2001 issue of the "Journal of Bone and Joint Surgery." The researchers conducted a survey...

  • RADIOLOGY Review. Hichkad, Nandan R. // Clinician Reviews;Mar2010, Vol. 20 Issue 3, p10 

    This article describes the evaluation of neck and right hand of a 57-year-old man involved in a motor vehicle crash. Radiograph of his right hand showed subtle linear lucencies, consistent with fractures but reveals no deformity. The patient was initially supported with a splint and later with a...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics