by Harold A. Yocum, MD
Harold A. Yocum, MD, is a member of the Committee on Professional Liability
In a recent closed claim study done by the Committee on Professional Liability on 94 pediatric closed claims, four claims involved casting.
You might say that you have "never cut anybody with a cast saw." Well, beware of wet casts and wet cast padding, especially the latter. When this occurs the cast padding becomes dry and hard, and does not offer the "padding" and the "give" that we are all accustomed to feeling when we are cutting the cast. When dry and hard, the padding can be cut with the cast saw. Two cases in the closed claim study involved injuries when the cast saw was used over a bony prominence of the arm or leg. This is probably less of a problem now due to the use of synthetic cast padding, but beware.
We all have received complaints about cast problems of one type or another. There may be a tendency to minimize the complaints and to suggest "elevation, ice, and keep your appointment in one to two weeks." These problems are so simple to check; do not take much time; and often can be done by your assistant, a physician assistant, orthopaedic technician or medical assistant.
There is no such thing as a hypochondriac in a cast. Have the patient come to your office and check the problem. If the problem is localized, window or split the cast, and if that is not enough, change the cast. This attention to detail regarding casting problems is good patient relations, shows a caring and concerned approach to patients and could easily prevent a lot of other potentially bad problems, such as we have seen on closed claims review. Two cases involved some permanent loss of the peroneal nerve function secondary to cast problems on the lower extremity.
Be cast conscious. Remember, there is no such thing as a hypochondriac in a cast!