A Novel Technique to Remove Plaster Ponseti Clubfoot Casts

Abstract

Serial Ponseti-style plaster of Paris casts are considered the gold standard treatment for clubfoot in infants. In conjunction with cast application, weekly cast removals are a necessary part of treatment, predisposing this patient population to cast saw injuries. Extensive research and education have been devoted to eliminating iatrogenic cast saw injuries. However, decreasing experience and familiarity with cast saws lead to a 1-2% incidence rate of cast saw burns or abrasions. While alternatives such as soaking the cast off or using protective strips are available, these lead to interruptions in clinic workflow and failure to successfully treat clubfoot, respectively. We present a technique which successfully and safely removes Ponseti-style plaster of Paris casts by perforating only the convex side of the cast, using superficial partial thickness scores, and a large cast spreader. The proposed technique can reduce cast saw injuries by potentially 50%.

Current Clubfoot Practices: POSNA Membership Survey

“…Further, they are more reliant on partial/general sedation and are more likely to perform tenotomies in the OR. A large percentage of respondents have observed cast saw injuries, indicating a need for the profession to develop and utilize safer methods for cast removal [ 32 ].…”

What’s New in Limb Lengthening and Deformity Correction

“…Monárrez et al suggested that dividing the Ponseti cast used for clubfoot management on only 1 side rather than the standard bivalve approach will reduce the incidence of cast-saw injuries during cast removal 72 . In a prospective randomized study, Li et al concluded that the routine use of tourniquets during high tibial osteotomies did not lead to a reduction in surgery duration, the incidence of intraoperative complications, or postoperative blood loss 73 .…”