Name of the Procedure:

Removal or Bivalving; Shoulder or Hip Spica, Minerva, or Risser Jacket

Summary:

This procedure involves either the removal or bivalving (cutting) of orthopedic casts, such as shoulder or hip spica, Minerva jacket, or Risser jacket. These are specialized orthopedic devices used to immobilize and support parts of the body after injury or surgery.

Purpose:

The procedure addresses conditions requiring immobilization to allow healing, such as fractures or surgical recovery. The goal is the safe removal or adjustment of the cast, ensuring continued healing without re-injury or additional complications.

Indications:

• Fractures that have healed sufficiently
• Completion of the prescribed duration in the cast
• Need to adjust the cast due to discomfort, pressure sores, or skin problems
• Diagnostic purposes, such as X-rays

Preparation:

• No specific fasting or medication adjustments required
• Diagnostic imaging (e.g., X-rays) to confirm the healing status
• Consultation with the orthopedic surgeon

Procedure Description:

1. Patient Positioning: The patient is positioned comfortably, ensuring easy access to the cast.
2. Cutting the Cast: Using specialized cast-cutting tools such as an oscillating saw, the healthcare provider makes precise cuts along the cast. Bivalving involves cutting down both sides to open the cast like a clamshell.
3. Removing the Cast: The cast is carefully opened and removed without disturbing the underlying soft tissues or joints.
4. Inspection: The underlying skin, muscles, and bones are inspected for any issues like sores or irritation.

Duration:

Typically takes 15 to 30 minutes.

Setting:

Performed in an outpatient clinic, hospital, or orthopedic surgeon's office.

Personnel:

• Orthopedic surgeon
• Nurse or medical assistant

Risks and Complications:

• Common Risks: Skin irritation, minor bleeding from skin abrasions
• Rare Risks: Re-injury to the previously immobilized area, infection, pressure sores

Benefits:

• Restoration of mobility
• Relief from the discomfort caused by the cast
• Allows for further diagnostic evaluation or additional treatment as needed

Recovery:

• Gentle mobilization and physical therapy may be advised.
• Routine skin care to address any irritation.
• Follow-up appointments to monitor healing progress.

Alternatives:

• Continuing with the cast if safe and recommended by the healthcare provider.
• Using a removable brace or splint if the situation allows.

Patient Experience:

• Initial relief from cast removal but some discomfort or stiffness may be felt.
• Skin may feel sensitive; any discomfort is manageable with recommended care.
• Pain management measures include over-the-counter pain relievers if needed.