Kelly Ryan D.O. Clinical faculty, Dept of Family Medicine , MedStar Franklin Square Medical Center. Teri McCambridge, MD, FAAP, Assistant Professor of Orthopedics and Pediatrics, University of Maryland School of Medicine

ABSTRACT:

This study evaluated patient satisfaction and skin integrity after immobilization with AquaCast^® waterproof liner. Waterproof liner, an emerging technology, is designed to allow proper fracture immobilization, participation in water activities and improved hygiene. Only short arm, long arm, or short leg casts were included.

This study was a retrospective non-randomized survey with de-identified patient information. The study included seventy-two patients, aged 24 months to 64 years (mean 11.7 years). Reduced fractures were excluded. AquaCast Liner was provided free for participation.

Seventy-one out of seventy-two patients (98.6%) wearing AquaCast Liner had average or better skin quality. Seventy-one out of seventy-two patients would recommend AquaCast Liner to others. All fractures healed without complication.

 Mauricio Silva1-3, Tigran Avoian1, Robert Sean Warnock1, Gal Sadlik1 and Edward Ebramzadehb2-3. 1Orthopaedic Institute for Children, 2The J. Vernon Luck Orthopaedic Research. Center, Orthopaedic Institute for Children and 3 UCLA/Orthopaedic Hospital. Department of Orthopaedics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA

ABSTRACT:                                                                                                                                                                        J Pediatr  Orthop B 26:417–423

Waterproof casting has been reported to increase patient comfort and satisfaction, and decrease skin irritation. There are no available data on the influence of waterproof casting materials on physical function in pediatric patients. Our aim was to determine whether the use of waterproof casting would result in faster recovery of physical function while maintaining similar clinical outcomes as those obtained with nonwaterproof materials. Twenty-six children with nonangulated or minimally angulated distal radius fractures were assigned randomly to initially receive a short-arm cast made of one of two optional materials: a hybrid mesh material with a waterproof lining or fiberglass with a nonwaterproof skin protector. Two weeks later, the initial cast was removed and replaced with a short-arm cast made of the alternative option. We compared the rate of fracture displacement, physical function, pain, skin changes, itchiness, and patient satisfaction. No evidence of displacement was found in either group. The mean Activities Scale for Kids – Performance (ASK-P) (physical function) score was 10% higher during the period of time when a waterproof cast was used (P=0.04). When a waterproof cast was used during the first 2 weeks of treatment, the mean total ASK-P scores were 23% higher than that when a nonwaterproof one was used during the same period of time (P=0.003). Patients who received a waterproof cast as the initial treatment reported lower functional scores overall and in almost every domain of the ASK-P once they were in a nonwaterproof one; similarly, those who received a nonwaterproof cast as the initial treatment reported higher functional scores overall and in every domain of the ASK-P once they were in a waterproof cast. Compared with a nonwaterproof cast, the use of waterproof casting resulted in comparable levels of pain, itchiness, skin irritability, and overall patient satisfaction. The results of this randomized, cross-over trial suggest that the use of waterproof casting material for the treatment of nondisplaced or minimally displaced distal radius fractures in children can result in a faster recovery of physical function, while providing comparable stability, pain, itchiness, skin irritability, and overall patient satisfaction.

Amanda VanInwegen and H Robert Tuten. Department of Chemistry, Virginia Commonwealth University School of Pharmacy, USA

ABSTRACT:                                                                              Biomed J Sci & Tech Res.                        DOI: 10.26717/BJSTR.2018.02.000787                                                                                                   

Background: The study was designed to investigate the prevalence and determinants of waterproof casting in children being treated for a fracture at a pediatric orthopedic surgery clinic. Patients whose fractures need immobilization with a cast are given the option to pay for a waterproof liner, which is not covered by insurance carriers. The determining factors in their decision can include sex, age, time of year, and price.

Methods: Subjects were selected for this study if they were placed in a fiberglass cast within a one-year period. The following information was compiled for each patient: sex, age, date of treatment, type of cast, and type of insurance (private, Medicaid, etc.). Also noted was whether or not the patient opted for waterproof casting. All of the patients were immobilized in a cast for approximately the same length of time.

Results: A total of 2407 casts were applied in the one-year period of the study, 960 (39.9%) of them with a waterproof liner. The prevalence of waterproof cast use was highest in privately insured patients, for children over the age of five, and during the warmer months. The lowest percentage of waterproof casts was among patients insured by Medicaid, the government program for families with limited financial resources.

Conclusion: Waterproof casts are of value to pediatric patients and their parents because they allow children to continue with their normal hygiene regimen and recreational activities, but at a cost that it considered too high for some. Providing the option of a waterproof cast benefits both the practice and the patient.

Elizabeth G. Shannon, RN, PhD(c), PNP, Rachel DiFazio, RN, MSN, PNP, James Kasser, MD, Lawrence Karlin, MD, and Peter Gerbino, MD. Children’s Orthopaedic Surgery Foundation & Harvard School of Medicine, Boston, Massachusetts. Children’s Hospital Boston, Boston, Massachusetts.

ABSTRACT:                                                                                                                                                                         J Pediatr Orthop 2005;25:56–59)                                                                          

This study was designed to determine the efficacy of waterproof cast-lining materials in children with short-arm, long-arm, and short-leg casts. Eligible patients had healing fractures 2 weeks after reduction, stable fractures requiring no reduction, or sprains. A total of 165 waterproof-lined casts were applied and 124 children and parents completed a survey (76.9%) upon cast removal.

Results: revealed 79% very satisfied, 21% satisfied, and 0% dissatisfied. There were 16 (12.9%) minor skin integrity issues. Waterproof casts in stable fractures and sprains allow acceptable immobilization with no significant associated unusual risk and allow children to resume their usual recreational water activities and hygiene regimen without risk of adverse results.