Retained foreign objects in casts in children

Abstract

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.

Improved Comfortability and Satisfaction of Hybrid-mesh Casts in the Conservative Management of Pediatric Supracondylar Humeral Fractures: A Randomized Controlled Trial

“…3,4 In addition, as moisture retained within the cast causes itch, it was reported that pediatric patients often insert foreign objects in the cast, in an attempt to alleviate the itch. 5 The insertion of foreign objects such as stationary and coins could lead to complications such as pressure sores, skin infections, thermal injuries, and joint stiffness. 5,6 The exposure of nonwaterproof fiberglass cast to water resulting in a wet cast could also lead to skin maceration and breakdown.…”

“…5 The insertion of foreign objects such as stationary and coins could lead to complications such as pressure sores, skin infections, thermal injuries, and joint stiffness. 5,6 The exposure of nonwaterproof fiberglass cast to water resulting in a wet cast could also lead to skin maceration and breakdown. 6 The resulting damaged skin barrier could also facilitate the entry of bacteria and fungi leading to infections.…”

“…6 The resulting damaged skin barrier could also facilitate the entry of bacteria and fungi leading to infections. 5,6 Hence, the use of the waterproof hybrid-mesh (HM) cast and lining has been gaining traction in recent years. It is marketed as a lightweight cast that allows patients to shower with the cast on.…”

“…The exposure of nonwaterproof fiberglass cast to water resulting in a wet cast could also lead to skin maceration and breakdown 6 . The resulting damaged skin barrier could also facilitate the entry of bacteria and fungi leading to infections 5,6 …”