Cast Removal.

Cast removal is a routine yet critical procedure in pediatric orthopaedic care, requiring meticulous attention to safety and detail to prevent avoidable complications such as thermal injury, lacerations, and subsequent patient anxiety. This review provides a comprehensive overview of best practices as it relates to safe cast removal, highlighting techniques, equipment considerations, and common pitfalls. Cast saws remain the standard tool for cast removal; however, improper use can result in friction burns or skin lacerations, particularly in young patients with thinner soft-tissue envelopes. Strategies to mitigate these risks include regular cast saw blade maintenance, proper saw angulation, intermittent cutting techniques, cooling of the blade, and the use of protective padding. Emerging technologies such as cast spreaders, alternative cutting tools, and water-softenable casting materials may further improve safety profiles. Additionally, patient cooperation and comfort plays a crucial role in safe cast removal, creating a calming environment and using child-friendly communication is paramount. In rare cases, sedation can be considered to help safely remove a cast in a traumatized child. This review synthesizes current evidence on the biomechanics of cast saws, injury risk factors, and training recommendations to enhance safety during cast removal.

Key concepts: (1)Proper Cast Saw Technique - Intermittent cast saw application with a perpendicular saw angle minimizes heat generation and reduces the risk of thermal injury and soft tissue damage.(2)Adequate Padding Assessment - Ensuring at least two layers of cast padding and a stockinette before cast removal decreases the likelihood of skin lacerations or pressure injuries.(3)Patient Positioning and Cooperation - Stabilizing the limb and maintaining patient comfort during cast removal reduces movement-related errors and improves safety.(4)Use of Cast Spreaders - After initial saw cuts, cast spreaders should be employed to avoid excessive blade contact and potential injury.(5) Careful inspection of the cast saw prior to cast removal and regular blade replacement when dull helps prevent avoidable cast saw injuries.