Keeping the cast dry

The image is CC by  Mattieu Guionnet.
The image is CC by Mattieu Guionnet.

I love the study from McDowell et al. where they tested different methods for keeping casts dry. It is simple but takes up a both common and important issue that we doctors frequently forget about. They compare six different methods and it seems that double plastic bags secured with duct tape provide the best protection for the money.

As all study there are some issues that can be worth remembering when reading the study:

  • The mannequin legs used are rather dissimilar from human skin: there is no fat, hairs, plasticity, etc.
  • Submerging the cast may not be equivalent to a shower. A simpler alternative may work if you only intend to shower.
  • Duct tape may be an overkill, especially considering the previous bullet point. A somewhat concerning detail is the description: “Approximately 18.29 meters (20 yards) of a package of duct tape were used for each plastic bag.” – that is a lot of duct tape…
  • Ease of use may be dependent on the testing order due to the learning curve. A randomized testing order may have solved this.
  • Patient compliance may depend on more than ease of use on a mannequin leg, e.g. the easy of estimate can on a mannequin not properly include the pain from tape removal.

Summary

While the study has some obvious issues it does shed some light on an important issue. It is also inspiring to see this kind of thinking outside the box, I would like to commend the authors on getting this published in the highest ranking orthopaedic journal.

M. McDowell, S. Nguyen, och J. Schlechter, ”A Comparison of Various Contemporary Methods to Prevent a Wet Cast”, The Journal of Bone & Joint Surgery, vol 96, num 12, s e99, jun 2014.

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