
Overview
This module describes how to remove plaster casts.
Indications
Immobilisation period has ended
Cast wetness or damage
Foreign object under a cast
Numbness, pain, tingling, or other signs that a cast is too tight
Concern about infection under a cast
Contraindications
None
Patient information and consent
How do I explain this procedure?
“I’m going to use a vibrating saw, cutters, and a cast opener to cut through the cast and then crack it open.”
What can my patient expect?
“The saw may look scary, but the blade does not rotate, it just vibrates, so it doesn’t cut skin, only cast.”
What is my patient’s role?
“Let me know if anything feels uncomfortable or painful while I am cutting off the cast.”
Preparation

Documentation
Patient notes
Equipment
Alcohol-based hand rub
A vibrating cast saw or Stille plaster shear
Blunt-tipped shears
Cast spreaders
Linen saver
Site & Positioning
Position the patient with the cast in easy reach.
Procedure
Follow medical asepsis without gloves.
Perform hand hygiene.
Put the linen saver under the cast to collect dust from the procedure.
Use the cast saw to cut all the way along the long axis of the cast until you reach the underlying padding. Select a line to cut away from bony prominences.
Cut padding with the shears.
Insert the cast spreader and crack the cast open a few times along its length.
If necessary, cut a second channel on the other side of the cast.
Remove the cast.
Dispose of medical waste safely.
Record completion of the procedure in patient notes.
Troubleshooting
My patient is terrified of the cast saw.
It is helpful to demonstrate its safety, firstly by pressing it against your own palm, then the patient’s palm, to show that it is not spinning but simply oscillating.
I’m struggling to make progress with the saw.
Press the cast saw all the way through the depth/thickness of the cast at one site at a time, don’t push it along.
Risks
Friction burns or abrasions to the skin from the cast saw
Cutting the skin with shears (more likely if not using blunt-tipped shears)
References
McCue JY. How to Remove a Cast. MSD Manual. 2021. Available from: https://www.msdmanuals.com/professional/injuries-poisoning/how-to-do-casting-procedures/how-to-remove-a-cast