Cast immobilization is a noninvasive and effective option in the treatment of fractures in children. However, its use can be associated with complications, such as pressure sores, skin infections, thermal injuries, and joint stiffness. In clinical practice, retained foreign objects in casts are not uncommon. This study aims to ascertain reasons for foreign objects being retained in casts and their effects on the skin. Eighteen children with retained foreign objects in their casts were identified and interviewed. Patient demographics, type of fracture and cast applied, nature of foreign body, and medical complications caused directly by the foreign object were also recorded for analysis. The foreign objects retained included coins, stationery, toy parts, cutlery, and hygiene items. The most common reason for their retention was to relieve itch, followed by accidental insertion and deliberate play. More than half of the children did not suffer complications, and the rest were all skin complications, with the most severe one being an infected skin ulcer that required oral antibiotics. Although the complications of retained foreign bodies are limited to the skin, they can worsen with delayed treatment. Cast care and itch reduction advice must be clearly communicated to patients and their caregivers. Foreign objects in casts must be emergently removed. Level of Evidence: Level 4 Evidence.

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Background: The incidence of atypical femoral fractures (AFF) is estimated at 70 to 100 per 100,000 patients. They are seen in patients who have undergone a prolonged course of bisphosphonate therapy. In one study, Asian women were found to have a more than 6-fold increase in the relative risk of AFF compared to Caucasians. It is also noticed that Asians have increased prevalence of bowing of the femur. This presents a challenge in the surgical management of AFF in Asians. Case Summary: A 76-year-old woman presented to our institution after experiencing left lower limb weakness and fell subsequently. She sustained a left AFF. Radiographs and magnetic resonance imaging also revealed ongoing stress injury to her right femur. Both femurs were severely bowed. Prior to this, she has been undergoing alendronate therapy for 30 months for osteoporosis. She had no other fragility fractures. She claimed to have left thigh pain for 12 months before this presentation. She underwent plate osteosynthesis of her left femur spanning the femoral head and neck up to the supracondylar flare. She also had prophylactic fixation of her right femur with plate osteosynthesis. Conclusion: A newer entity of AFF in patients on short term bisphosphonates use with severely bowed femurs should be recognised. Where there is difficulty in performing intramedullary nailing for these group of patients, whole length plating of the femur should be considered.