The Role of Blade Wear and Cure Time in the Prevention of Cast Saw Injuries

Placement and valving of a fiberglass cast is a common practice in the treatment of pediatric fractures and is commonly performed in the emergency department by resident physicians. There are inherent risks in this process that represent a real risk of patient morbidity, including burns and abrasions. Additionally, the average cast saw injury is estimated to cost the health system $8,000. Quality improvement projects directed at minimizing cast saw injuries have demonstrated success through education in appropriate valving technique, and practice of technique through simulation. However, the research to date has addressed only a limited number of risk factors associated with cast saw injury and only in plaster casting. Our research would significantly contribute to the existing knowledge surrounding fiberglass cast saw injuries and better inform quality improvement plans aimed at mitigating risk to the patient and reducing healthcare costs. Specific Aims This project seeks to address a lack of clinical practice guidelines surrounding the prevention of cast saw injuries during the valving of fiberglass casts. Applying a fiberglass cast in the acute setting of a pediatric forearm fracture for nonoperative management is a common practice in pediatric orthopedics. Valving a cast involves using a saw to make a longitudinal cut in a cast and is performed to allow for swelling in patients with acute forearm fractures. Valving a fiberglass cast comes with inherent risks to the patient in the form of cast saw burns and abrasions. This is most commonly due to sustained forceful contact to the skin of the patient or saw blades that have reached unsafe temperatures. While previous studies have shown that a curing time of 12 minutes significantly reduces the number of blade-to-skin touches during monovalving a plaster cast, but no equivalent research has been conducted to determine the curing time needed for fiberglass casts. Additionally, there is little research, and no manufacturer recommendations, regarding the frequency of cast blade changes needed to minimize blade temperature, or blade to skin touches. The specific aims of this project are to: 1) Determine the cure time at which blade to skin touches and blade temperature are minimized during valving of a fiberglass cast; and 2) Determine the number of times that a cast saw blade can be used before the blade temperature and number of blade to skin touches increases during the valving of a fiberglass cast. Addressing these aims will allow us to make recommendations regarding the frequency of blade changes and the recommended curing time for fiberglass cast valving. These results can then be applied to minimize patient morbidity during fiberglass cast valving.