Thermal Injury with Contemporary Cast-Application Techniques and ...

THE JOURNAL OF BONE & JOINT SURGERY · JBJS.ORG
VOLUME 89-A · NUMBER 11 · NOVEMBER 2007
portant as there is a risk of thermal injury when a fracture is
splinted postoperatively. All too often, a splint is folded over
when it has been cut to an inappropriate length, but this essentially
doubles its thickness in a small area and thus increases
the local exothermic reaction. Our recommendation
is to trim excess plaster and resist the temptation to fold over
the ends.
We have offered potential interventions for reducing
thermal risk, such as placing ice packs between the limb and
the pillow. Safer ways to avoid the risk of thermal injury in this
setting would be to hold the limb or allow it to hang free during
the curing process. The use of isopropyl alcohol to decrease
the temperature of a curing cast has been reported
anecdotally 17 . Our attempts to use it in this way revealed that,
while the external temperature of the cast may go down, the
internal temperature is minimally affected. In fact, the clinician
may be fooled into thinking that the interior of the cast is
cool because he or she can feel the external surface of the cast
cooling (Fig. 7).
In conclusion, the data on plaster material that were derived
with the current model support previous authors’ findings,
in particular that application of thicker plaster casts with
use of higher dip-water temperatures and placement of the
limb on a pillow may lead to temperatures high enough to
cause thermal injury. In addition, we were able to determine
the temperature at various locations on the limb under the
cast. This information is important so that clinicians realize
that, while the temperature at one location of the cast may feel
safe, the temperature elsewhere (i.e., in contact with the pil-
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T HERMAL INJURY WITH CONTEMPORARY CAST-APPLICATION
TECHNIQUES AND METHODS TO CIRCUMVENT MORBIDITY
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Appendix
Three additional figures, including a plot of skin surface
and external temperatures of a twelve-ply cast applied to
the arm of an investigator, a comparison of skin (human) and
surface (model) temperatures after application of a twelve-ply
cast (37°C), and a graph of representative plots of temperatures
causing thermal injury (reference lines) are available with the
electronic versions of this article, on our web site at jbjs.org
(go to the article citation and click on “Supplementary Material”)
and on our quarterly CD-ROM (call our subscription
department, at 781-449-9780, to order the CD-ROM).
NOTE: The authors thank the University of Wisconsin School of Biomedical Engineering students
Stacey Hoebel, Kristin LaFortune, Katie Mantz, and Liz Thottakara for their help in the
development and design of the experimental limbs used in this study.
Matthew A. Halanski, MD
Amy D. Halanski, MD
Ashish Oza, BS
Ray Vanderby, PhD
Alejandro Munoz, PhD
Kenneth J. Noonan, MD
Department of Orthopaedics and Rehabilitation, University of Wisconsin,
K4/732 Clinical Science Center, 600 Highland Avenue, Madison, WI
53792. E-mail address for K.J. Noonan: noonan@orthorehab.wisc.edu
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