Name of the Procedure:

Wedging of Cast (except clubfoot casts)

Summary

The wedging of a cast is a medical technique used to correct or adjust the position of bones during the healing process by strategically cutting and wedging the cast to change its alignment.

Purpose

This procedure addresses the improper alignment of bones healing in a cast. The goal is to adjust the cast to ensure the bones heal in the correct position, preventing long-term deformities or dysfunctions.

Indications

• Malalignment of bones after a fracture despite initial casting
• Patients with healing fractures that are not set correctly
• Swelling reduction that alters the initial fit of the cast

Preparation

• The patient usually does not need to fast.
• Wear loose clothing to accommodate the cast.
• Pre-procedure imaging (like X-rays) to assess bone positioning.
• Review medications with a healthcare provider.

Procedure Description

1. Assessment: The cast is first examined to determine the need for adjustment.
2. Marking: Areas of the cast are marked where cutting is required.
3. Cutting: A specialized cast saw is used to carefully cut the marked sections without injuring the skin.
4. Wedging: The cast is then manipulated; a wedge is either added or removed to change the bone alignment.

5. Securing: New casting material is applied over the adjusted area to secure the new position.

   Tools: Cast saw, wedges, protective padding, new casting material. Anesthesia: Typically, none or local anesthesia if there is discomfort.

Duration

The procedure typically takes 30 minutes to 1 hour.

Setting

Performed in an outpatient clinic or hospital setting.

Personnel

• Orthopedic surgeon or specialist
• Nurses or casting technicians

Risks and Complications

• Skin irritation or pressure sores
• Recurrent malalignment requiring further adjustments
• Rarely, nerve injury or circulation issues in the limb

Benefits

• Proper bone healing and alignment
• Prevention of long-term deformities and dysfunctions
• Improved comfort and mobility during the healing process

Recovery

• Keep the cast dry and clean.
• Avoid putting weight on the affected limb unless instructed otherwise.
• Follow-up x-rays to confirm proper alignment and healing.
• Report any increased pain, swelling, or changes in sensation.

Alternatives

• Recasting the limb entirely
• Surgical intervention in severe cases
• Comparing the efficacy, alternatives may involve more invasive procedures or longer recovery times.

Patient Experience

Patients might experience some discomfort during the wedging but pain is typically minimal. There may be mild soreness afterwards. Pain management includes over-the-counter pain relievers or prescribed medications for comfort.