CAST SAW

A CAST SAW

Just imagine this is the day that you have fully recovered from a severe injury on your hand or leg and your plaster cast will be removed from your recovered body part. Then suddenly ! A doctor comes having a huge saw and saying “Now, this will help me remove your plaster cast !”. How will you feel ? Of course, you will feel scared and have shivers throughout your whole body.

USE OF A CAST SAW

And that’s why “Cast Saw” were invented. Unlike the circular saws, a cast saw is a specialized medical equipment that is an oscillating power tool used to remove orthopaedic casts. In this blog we are going to know about its historical facts, types of casts saw its working, what could possibly go wrong while handling it? and precautions one need to take while working with it.

HISTORY OF CAST SAW

DR. HOMER STRYKER

The Stryker saw, also known as Today's Cast Saw, was innovated by Dr. Homer Stryker, an orthopaedic specialist who dedicated his life to create medical apparatus that catered to his patients' specific needs. Dr. Stryker observed the challenges faced by orthopaedic practitioners in manually removing casts, encouraging him to devise the Stryker saw to simplify the process. Initially named The Cast Cutter, this saw was designed incorporating an oscillating blade, which was originally driven by a motor sourced from a malted milk mixer. The blade's back and forth movements allowed the creation of a linear incision(a surgical cut made on the skin) through rigid cast material, while carefully bypassing delicate human tissue. These swift and minor motions allowed for effective penetration of tough surfaces while safeguarding the pliable and flexible skin layer. In the era of medical examination and medicolegal investigations, the Stryker saw emerged as a valuable tool, facilitating autopsies without causing harm to vital tissues. As a swift and proficient alternative to the conventional bone saw of its era, the criteria for consumer expectations from autopsy saws have subsequently evolved.

DR. HOMER STRYKER

TYPES OF CAST SAWS

There are in general seven kinds of cast saws in use by experts and they are as follows:

1. Electric Cast Saws: Electric cast saws are widely used in medical settings for the removal of casts. They operate using an electric motor to power the saw blade's oscillating motion. These saws are known for their efficiency and precision in cutting through cast materials, such as plaster or fiberglass. They are designed to minimize the risk of injury to the patient's skin while ensuring quick and safe cast removal.

2. Oscillating Cast Saws: Oscillating cast saws are a specific type of electric saws that work by rapidly oscillating the saw blade back and forth. This motion allows for controlled and precise cutting, reducing the chances of cutting the patient's skin underneath the cast. The oscillating action also generates less heat, making it a safer option compared to traditional rotating saws.

3. Pneumatic Cast Saws: Pneumatic cast saws are powered by compressed air and are used in situations where electric power might not be feasible, such as in operating rooms. These saws offer similar cutting efficiency as electric cast saws and are often chosen for their reliability and safety features.

4. Battery-Powered Cast Saws: Battery-powered cast saws combine the portability of pneumatic saws with the convenience of electric saws. They are equipped with rechargeable batteries, allowing medical professionals to use them without being tethered to a power source. This type of cast saw is especially useful in situations where mobility is essential, such as in emergency or field medical settings.

5. Low-Speed Cast Saws: Low-speed cast saws are designed to minimize the risk of cutting or damaging the patient's skin during cast removal. These saws operate at lower speeds compared to traditional high-speed electric saws. They are particularly useful when working with casts that are near sensitive areas or when the patient has a higher risk of skin complications.

6. Water-Cooled Cast Saws: Water-cooled cast saws incorporate a water spray system to cool down the blade during cutting. This cooling mechanism helps reduce the heat generated by friction during cast removal, minimizing discomfort for the patient and reducing the risk of thermal injury to the skin.

7. Disposable Cast Saws: Disposable cast saws are single-use devices designed for infection control and prevention. They are made for specific cutting tasks and are discarded after use to prevent cross-contamination. These saws are commonly used in situations where maintaining sterility is crucial.

WORKING OF CAST SAW

WORKING OF A CAST SAW

As I explained earlier, a cast saw stands as an oscillating power tool primarily utilized for the removal of orthopaedic casts. But unlike, a circular saw, recognized for its rotating blade, the cast saw employs a fine-toothed blade that oscillates or vibrates rapidly and minutely over a very minute angle to effectuate material cutting. This instrument is frequently employed alongside a cast spreader, increasing its functionality. During its operation, the cast saw's blade makes contact with the patient's skin, yet its design is such that it generally avoids cutting the skin. It's worth noting, that in regions of the body where tissue density is lower and bones are exposed, the blade can potentially cause cuts and slashes. The tool's construction has been precisely devised to permit the cutting of rigid substances like plaster or fiberglass, all while accommodating the back and forth movement of the soft tissues like skin. This motion effectively disperses shear forces, thus reducing the risk of injury.

Also, a standard technique for employing the cast saw entails a preliminary demonstration before the actual cast-cutting procedure takes place. This precautionary measure ensures both the operator's familiarity with the tool's operation and the patient's comfort and safety during the cast removal process. Moreover, the cast saws have seen advancements in blade materials and ergonomic designs (having to be designed for efficiency and comfort in the working environment), which further contribute to enhanced efficiency and patient well-being during cast removal. Medical professionals now undergo specialised training to utilize these tools effectively, ensuring optimal outcomes for both patients and its user.

THINGS THAT COULD POSSIBLE GO WRONG

Several issues can arise when working with a cast saw, underscoring the necessity for its operation by individuals versed in appropriate cast saw techniques. While it is expected that healthcare providers possess adept knowledge of these techniques, proficiency in using this device extends to cast technicians, physician assistants, and medical assistants as well.

A study revealed that common complications during cast removal stemmed from factors such as worn-out blades, inadequate cast padding, and insufficient training or experience. The incidence of injuries attributed to cast saws varies, typically ranging from less than 1% to around 4%. Consequently, while the risk is minor, it remains existent. Predominant issues encountered encompass:

A BURN

1. Burns: Skin burns represent a prevalent concern during cast removal procedures involving a cast saw. The oscillating motion of the blade can induce elevated temperatures due to friction against the cast material. When contact between the heated blade and the skin occurs, burns can manifest. Employing lighter pressure on the saw to curb blade heating and permitting a heated blade to cool down can be effective in preventing this issue. Notably, research has indicated that temperatures tend to be higher when cutting through fiberglass cast material in comparison to plaster.

A CUT

2. Cuts: Incidences of minor skin lacerations are infrequent yet plausible. The blade's teeth possess sufficient sharpness to abrade the skin. The presence of substantial padding beneath the hard cast material diminishes the likelihood of skin lacerations.

In the event that you suspect sustaining an injury resulting from cast removal, it is imperative to notify your healthcare provider. Timely communication empowers your provider to proactively manage and address issues like abrasions and burns, thereby ensuring appropriate care and attention.

PRECAUTIONS TO BE TAKEN WHILE USING A CAST SAW

PRECAUTIONS TO BE TAKEN

The utilization of a cast saw necessitates careful attention to a range of potential risks, which predominantly fall under the categories of thermal and abrasive injuries. In order to ensure the safety and well-being of both patients and medical practitioners, several precautionary measures are paramount.

Thermal Injury Mitigation:

1. Optimal Cast Saw Specifications: It is imperative to utilize a cast saw equipped with appropriate specifications, including the presence of an attached vacuum. This aids in minimizing the accumulation of heat generated during the cutting process, thus reducing the risk of thermal injuries.

2. Blade Sharpness: The use of a sharp blade is crucial. Dull blades can heighten the temperature generated due to friction, leading to potential burns. Regular inspection and maintenance of the blade's sharpness are vital components of injury prevention.

3. Avoiding Concavities: Care should be exercised when cutting in concave regions, as these areas can trap heat and intensify the risk of burns.

4. Padding Considerations: Ensuring sufficient padding between the blade and the patient's skin is essential. Padding that is too thin or overly thick casting materials can increase the likelihood of thermal injuries.

Preventing Abrasive Injuries:

1. Blade Sharpness and Design: The blade's sharpness and design play a role in preventing abrasive injuries. A well-maintained, properly designed blade minimizes the risk of skin abrasions during the cast removal process.

2. Mindful of Boney Prominences: When cutting over bony prominences, such as elbows or ankles, heightened caution is required. Adequate padding and adjusted cutting techniques can reduce the risk of abrasions in these sensitive areas.

Adopting Appropriate Techniques:

1. In-Out Technique: One of the core techniques for mitigating thermal injuries involves the "in-out technique." This approach prevents prolonged contact of the hot blade with the skin, significantly lowering the risk of burns.

2. Avoiding Blade Dragging: Implementing the in-out technique simultaneously prevents "dragging the blade," which can potentially stretch and injure the skin. This technique maintains a controlled distance between the blade and the skin.

3. Teaching Proper Technique: Educating medical professionals about perforating rather than cutting the cast can be advantageous. This technique focuses on controlled entry and exit points, reducing the risk of injuries.

By diligently adhering to these precautions and integrating appropriate techniques, cast saw users can effectively minimize the occurrence of thermal and abrasive injuries, enhancing the safety and comfort of both patients and healthcare providers.

CONCLUSION

In conclusion, one can say that cast saws are special tools that help doctors take off casts without hurting people. They were invented a long time ago and have gotten even better over the years. By being careful and following the right steps, doctors can use cast saws safely and help patients feel better without any worries.

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IS THAT A DOCTOR USING A SAW ? OH ITS A CAST SAW