Merck Manual

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How To Remove a Cast

By

James Y. McCue

, MD, University of California San Francisco - Fresno

Last full review/revision Jun 2021| Content last modified Jun 2021
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Topic Resources

Casts should be removed by professionals using appropriate equipment.

Indications

  • Completion of the period of immobilization

  • Numbness, tingling, increasing pain, or any other sensation indicating the cast is too tight

  • Foreign body lodged between the skin and the cast

  • Cast damage or wetness

  • Concern about infection under the cast

Contraindications

  • A date that is before the prescribed period of immobilization

Complications

  • Injury to underlying skin (eg, abrasions, friction burn)

Equipment

There are several different tools that can be used to remove a cast:

  • Vibrating cast saw

  • Cast spreader

  • Blunt-tipped shears

Vibrating cast saws look like they could easily lacerate the skin, but they are quite safe.

Additional Considerations

  • Use a sheet or drape to collect dust generated from cutting the casting material.

  • If the cast saw has an attached vacuum hose, use it to collect the dust.

  • Wear appropriate eye and respiratory protection to protect against flying cast debris.

Positioning

  • The patient should be positioned to provide the operator with optimal access to the extremity with the cast.

Step-by-Step Description of Procedure

  • Introduce the vibrating cast saw to the patient, and touch it to your own palm to demonstrate that it does not hurt and will not cut the skin.

  • Score the cast along its long axis.

  • Continue cutting the cast in the channel created by scoring until the underlying padding is reached.

  • Cut the padding and stockinette with blunt-tipped shears.

  • Insert the cast spreader between the cut cast edges.

  • Spread the cast apart using the cast spreader.

  • Remove the cast.

Aftercare

  • Clean the extremity of accumulated dried skin and oils using soap and water.

  • Arrange or recommend appropriate physical therapy if needed (eg, for joint stiffness).

Warnings and Common Errors

  • To avoid injury to the underlying skin, do not continue to apply pressure with the cast saw at the same location after cutting through the plaster or fiberglass.

Tips and Tricks

  • Spreading the cast apart may be easier if both sides are cut rather than just one side.

  • Brace part of the hand holding the cast cutter on the cast for better control.

Click here for Patient Education
NOTE: This is the Professional Version. CONSUMERS: Click here for the Consumer Version
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