Name of the Procedure:

Removal or bivalving; full arm or full leg cast

Summary

This procedure involves removing or partially cutting through a full arm or full leg cast to alleviate pressure, reduce swelling, or prepare for further treatment.

Purpose

The main purpose is to relieve discomfort, decrease swelling, prevent complications like compartment syndrome, and allow access to the limb for additional medical care.

Indications

• Severe swelling under the cast
• Pain or discomfort indicating pressure or potential compartment syndrome
• Need for re-evaluation of the healing process
• Skin complaints such as itching or sores

Preparation

• Ensure the patient remains calm and informed throughout the process
• No special fasting or medication adjustments required
• Diagnostic tests such as X-rays may be performed to assess the condition of the limb

Procedure Description

1. Patient is positioned comfortably, often in a seated or reclining position.
2. A cast saw and spreader are used; the cast saw has a circular blade that oscillates to cut through the cast material without harming the skin.
3. For cast removal, the cast is cut on either side and then spread apart to lift it off the limb.
4. For bivalving, the cast is partially cut on both sides without complete removal, allowing the cast to open slightly and relieve pressure.

Duration

The procedure typically takes 15-30 minutes.

Setting

The procedure is generally performed in an outpatient clinic or a hospital's orthopedic department.

Personnel

• Orthopedic technician or clinical nurse specialist
• Orthopedic doctor (if necessary)

Risks and Complications

• Minor skin irritation or cuts from the saw
• Potential for limb movement causing discomfort
• Rarely, incomplete cast removal leading to prolonged discomfort

Benefits

• Immediate relief from pressure and pain
• Improved circulation and reduced risk of complications
• Faster access to the limb for continued treatment

Recovery

• Little to no downtime; patients can typically resume normal activities immediately
• Follow-up care instructions and potential re-casting as needed
• Monitoring for any signs of complications such as increased swelling or pain

Alternatives

• Monitoring and adjusting the cast without removal (if minor)
• Use of softer cast-liners or alternative casting materials
• Pros and cons of alternatives include potentially slower relief and longer time to address underlying issues

Patient Experience

During the procedure, patients may feel vibrations from the saw but should not feel pain. Post-procedure, they should feel immediate relief and reduced pressure. Pain management, if necessary, is generally minimal and includes over-the-counter analgesics.