What will the nurse tell the patient to expect while the cast saw is being used?

Casts are custom-made. They must fit the shape of your injured limb correctly to provide the best support. Casts can be made of plaster or fiberglass — a plastic that can be shaped.

Splints or half-casts can also be custom-made, especially if an exact fit is necessary. Other times, a ready-made splint will be used. These off-the-shelf splints are made in a variety of shapes and sizes and are much easier and faster to use. Some have Velcro straps which make the splints easy to put on, take off, and adjust.

Fiberglass or plaster materials form the hard, supportive layer in splints and casts.

Fiberglass is lighter in weight and stronger than plaster. In addition, X-rays can see through fiberglass better than through plaster. This is important because your doctor will probably schedule additional X-rays after your splint or cast has been applied. X-rays can show whether the bones are healing well or have moved out of place.

Plaster is less expensive than fiberglass and shapes better than fiberglass for some uses.

Both fiberglass and plaster splints and casts use padding, usually cotton, as a protective layer next to the skin. Both materials come in strips or rolls, which are dipped in water and applied over the padding covering the injured area. In some cases, special waterproof padding and cast material may be used. Your doctor will let you know if your cast is made and padded with these waterproof materials.

The splint or cast must fit the shape of the injured arm or leg correctly to provide the best possible support. Generally, the splint or cast also covers the joint above and below the broken bone.

In many cases, a splint is applied to a fresh injury first. As swelling subsides, a full cast may replace the splint. If a cast is initially applied to your injury, it may be “valved” (cut) to allow for swelling, then repaired at your first follow-up appointment.

Sometimes, it may be necessary to replace a cast as swelling goes down and the cast gets too big. As a fracture heals, the cast may be replaced by a splint to make it easier to perform physical therapy exercises.

1. Rees C.E. A Quick and Easy Method for the Removal of Plaster Casts. Calif. State J. Med. 1922;20:147. [PMC free article] [PubMed] [Google Scholar]

2. Lerwick J.L. Minimizing pediatric healthcare-induced anxiety and trauma. World J. Clin. Pediatrics. 2016;5:143–150. doi: 10.5409/wjcp.v5.i2.143. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

3. Von Baeyer C.L., Marche T.A., Rocha E.M., Salmon K. Children’s memory for pain: Overview and implications for practice. J. Pain. 2004;5:241–249. doi: 10.1016/j.jpain.2004.05.001. [PubMed] [CrossRef] [Google Scholar]

4. Rodriguez C.M., Clough V., Gowda A.S., Tucker M.C. Multimethod assessment of children’s distress during noninvasive outpatient medical procedures: Child and parent attitudes and factors. J. Pediatric Psychol. 2012;37:557–566. doi: 10.1093/jpepsy/jss005. [PubMed] [CrossRef] [Google Scholar]

5. Pate J.T., Blount R.L., Cohen L.L., Smith A.J. Childhood Medical Experience and Temperament as Predictors of Adult Functioning in Medical Situations. Children’s Health Care. 1996;25:281–298. doi: 10.1207/s15326888chc2504_4. [CrossRef] [Google Scholar]

6. Lee Smith M. Interventions to Minimize Distress during Pediatric Primary Care Visits: A Systematic Literature Review. Volume 4 Brigham Young University; Provo, UT, USA: 2014. [Google Scholar]

7. Maclaren J.E., Cohen L.L. Interventions for paediatric procedure-related pain in primary care. Paediatr. Child Health. 2007;12:111–116. [PMC free article] [PubMed] [Google Scholar]

8. Trottier E.D., Doré-Bergeron M.J., Chauvin-Kimoff L., Baerg K., Ali S. Managing pain and distress in children undergoing brief diagnostic and therapeutic procedures. Paediatr. Child Health. 2019;24:509–535. doi: 10.1093/pch/pxz026. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

9. The Hospital for Sick Children (SickKids). Acute Pain: How to Treat and Manage in Young Children. [(accessed on 15 August 2020)]; Available online: https://www.aboutkidshealth.ca/article?contentid=3637&language=english

10. Wiggins C.E., Brown K.D. Hearing protection and cast saw noise. J. South Orthop. Assoc. 1996;5:1–4. [PubMed] [Google Scholar]

11. Arksey H., O’Malley L. Scoping studies: Towards a methodological framework. Int. J. Soc. Res. Methodol. 2005;8:19–32. doi: 10.1080/1364557032000119616. [CrossRef] [Google Scholar]

12. Levac D., Colquhoun H., O’Brien K.K. Scoping studies: Advancing the methodology. Implement. Sci. 2010;5:69. doi: 10.1186/1748-5908-5-69. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

13. Peters M.D., Godfrey C.M., Khalil H., McInerney P., Parker D., Soares C.B. Guidance for conducting systematic scoping reviews. Int. J. Evid. Based Healthc. 2015;13:141–146. doi: 10.1097/XEB.0000000000000050. [PubMed] [CrossRef] [Google Scholar]

14. Ouzzani M., Hammady H., Fedorowicz Z., Elmagarmid A. Rayyan—A web and mobile app for systematic reviews. Syst. Rev. 2016;5:210. doi: 10.1186/s13643-016-0384-4. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

15. Hoffmann T.C., Glasziou P.P., Boutron I., Milne R., Perera R., Moher D., Altman D.G., Barbour V., Macdonald H., Johnston M., et al. Better reporting of interventions: Template for intervention description and replication (TIDieR) checklist and guide. BMJ. 2014;348:g1687. doi: 10.1136/bmj.g1687. [PubMed] [CrossRef] [Google Scholar]

16. Tufanaru C., Munn Z., Aromataris E., Campbell J., Hopp L. Joanna Briggs Institute Reviewer’s Manual. The Joanna Briggs Institute; Adelaide, Australia: 2017. Systematic reviews of effectiveness. [Google Scholar]

17. Carmichael K.D., Westmoreland J. Effectiveness of ear protection in reducing anxiety during cast removal in children. Am. J. Orthop. (Belle Mead NJ) 2005;34:43–46. [PubMed] [Google Scholar]

18. Johnson J.E., Kirchhoff K.T., Endress M.P. Altering children’s distress behavior during orthopedic cast removal. Nurs. Res. 1975;24:404–410. doi: 10.1097/00006199-197511000-00002. [PubMed] [CrossRef] [Google Scholar]

19. Johnson J., Kirchhoff K., Endress M. Easing children’s fright during health care procedures. Am. J. Matern. Child Nurs. 1976;1:206–210. doi: 10.1097/00005721-197607000-00006. [PubMed] [CrossRef] [Google Scholar]

20. Katz K., Fogelman R., Attias J., Baron E., Soudry M. Anxiety reaction in children during removal of their plaster cast with a saw. J. Bone Joint Surg. Br. 2001;83:388–390. doi: 10.1302/0301-620X.83B3.0830388. [PubMed] [CrossRef] [Google Scholar]

21. Ko J.S., Whiting Z., Nguyen C., Liu R.W., Gilmore A. A Randomized Prospective Study Of The Use Of Ipads In Reducing Anxiety During Cast Room Procedures. Iowa Orthop. J. 2016;36:128–132. [PMC free article] [PubMed] [Google Scholar]

22. Liu R.W., Mehta P., Fortuna S., Armstrong D.G., Cooperman D.R., Thompson G.H., Gilmore A. A randomized prospective study of music therapy for reducing anxiety during cast room procedures. J. Pediatric Orthop. 2007;27:831–833. doi: 10.1097/BPO.0b013e3181558a4e. [PubMed] [CrossRef] [Google Scholar]

23. Mahan S.T., Harris M.S., Lierhaus A.M., Miller P.E., DiFazio R.L. Noise Reduction to Reduce Patient Anxiety During Cast Removal: Can We Decrease Patient Anxiety With Cast Removal by Wearing Noise Reduction Headphones During Cast Saw Use? Orthop. Nurs. 2017;36:271–278. doi: 10.1097/NOR.0000000000000365. [PubMed] [CrossRef] [Google Scholar]

24. Schlechter J.A., Avik A.L., DeMello S. Is there a role for a child life specialist during orthopedic cast room procedures? A prospective-randomized assessment. J. Pediatric Orthop. B. 2017;26:575–579. doi: 10.1097/BPB.0000000000000310. [PubMed] [CrossRef] [Google Scholar]

25. Wong C.L., Ip W.Y., Kwok B.M.C., Choi K.C., Ng B.K.W., Chan C.W.H. Effects of therapeutic play on children undergoing cast-removal procedures: A randomised controlled trial. BMJ Open. 2018;8:e021071. doi: 10.1136/bmjopen-2017-021071. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

26. Lazarus R.S. Emotions and adaptation: Conceptual and empirical relations. In: Arnold W.J., editor. Nebraska Symposium on Motivation. Volume 16. University of Nebraska Press; Lincoln, NE, USA: 1968. pp. 175–269. [Google Scholar]

27. Schachter S., Singer J.E. Cognitive, social, and physiological determinants of emotional state. Psychol. Rev. 1962;69:379–399. doi: 10.1037/h0046234. [PubMed] [CrossRef] [Google Scholar]

28. Piaget J. The Psychology of Intelligence. Routledge & Kegan; London, UK: 1971. [Google Scholar]

29. Lazarus R., Folkman S. Stress, Appraisal, and Coping. Springer Publishing Company; New York, NY, USA: 1984. [Google Scholar]

30. Piaget J. The Origins of Intelligence in Children. W.W. Norton & Company Inc.; New York, NY, USA: 1963. [Google Scholar]

31. Trotman G.P., Veldhuijzen van Zanten J.J.C.S., Davies J., Möller C., Ginty A.T., Williams S.E. Associations between heart rate, perceived heart rate, and anxiety during acute psychological stress. Anxiety Stress Coping. 2019;32:711–727. doi: 10.1080/10615806.2019.1648794. [PubMed] [CrossRef] [Google Scholar]

32. Domecq J.P., Prutsky G., Elraiyah T., Wang Z., Nabhan M., Shippee N., Brito J.P., Boehmer K., Hasan R., Firwana B., et al. Patient engagement in research: A systematic review. BMC Health Serv. Res. 2014;14:89. doi: 10.1186/1472-6963-14-89. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

33. Manafo E., Petermann L., Mason-Lai P., Vandall-Walker V. Patient engagement in Canada: A scoping review of the ’how’ and ‘what’ of patient engagement in health research. Health Res. Policy Syst. 2018;16:5. doi: 10.1186/s12961-018-0282-4. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

34. Slattery P., Saeri A.K., Bragge P. Research co-design in health: A rapid overview of reviews. Health Res. Policy Syst. 2020;18:17. doi: 10.1186/s12961-020-0528-9. [PMC free article] [PubMed] [CrossRef] [Google Scholar]