Mythbusting Casting by Yosef Leibman, M.D.
Wednesday, August 5, 2009 Nothing in my life as an EP brings more satisfaction than being a mythbuster. The WJM used to have a column for these issues; IJEM had a column for clinical controversies for a while and CJEM continues this tradition. I put out a monthly periodical called the EMU (Emergency Medicine Update) where we review the literature and often get into these issues. I have found a great treasure trove of mythbusting can be found in the Journal of Family Practice and in the Emergency Medicine Journal.
Let us start with one - ever be real careful to use cold water for casting - of course - using warm water with the exothermic reaction of casting can cause burns, right? Well the EMJ says no - we do not use enough casting material on most of the body to cause burns (plus we use cotton underneath). True on the lower extremity we use enough, but it only gets to hot enough temperatures to cause a burn for less than a second - not enough to clinically cause a burn. See EMJ 25(12)827. Here is one more - are you using wet dressings for your wounds? (like op site or petroleum deressing?) Well they cause more migration of macrophages and seem to heal faster. Sure Mom said let it stay open to the air, but Mom was never double blinded or placebo controlled (at least my mother wasn't) (J Athl Train 43(6) 600).
Yosef Leibman MD
Specialist in EM
Editor in Chief EMU
Casting, EMU, Myths in Procedures
Reader Comments (1)
Another myth about casting...did you know that the "scaphoid plaster" is not evidence-based? There is no evidence that immobilisation of the proximal thumb makes any difference to the healing of scaphoid fractures. A study by Clay et al in the 1990's showed that there is no difference in the non-union rate (10%) when scaphoid plaster and Colles-type plaster is used. Someone just made it up and we've kept doing it...