OTC Orthopaedic Technologist Certified Cast Complications and Removal 4 — Questions and Answers
Question 1: A patient reports inserting a pencil inside their cast to scratch an itch and now has increased pain at that site. The FIRST priority is:
- Reassure the patient and apply ice externally
- Remove the cast and inspect for skin injury (Correct answer)
- Prescribe topical antibiotics through the cast opening
- Request an X-ray to rule out re-fracture
Correct answer: Remove the cast and inspect for skin injury
Foreign objects inside a cast can cause pressure sores or lacerations, so removing the cast to inspect the skin is the first priority.
Question 2: Thermal injury during cast removal is most commonly caused by:
- Heat generated by the oscillating saw blade (Correct answer)
- Ambient room temperature
- Body heat trapped under the cast
- Chemical reaction of the casting material
Correct answer: Heat generated by the oscillating saw blade
The oscillating saw blade generates friction heat, which can burn the skin if held too long in one spot, especially over bony prominences.
Question 3: Which patient population requires the MOST vigilance for pressure complications during cast immobilization?
- Athletic young adults
- Patients with diabetes or peripheral neuropathy (Correct answer)
- Pediatric patients under age 10
- Post-surgical patients with normal sensation
Correct answer: Patients with diabetes or peripheral neuropathy
Patients with diabetes or peripheral neuropathy have impaired sensation and cannot reliably detect pressure-related pain under a cast.
Question 4: After cast removal, the skin commonly appears:
- Deeply tanned and thickened
- Pale, scaly, and with accumulated dead skin cells (Correct answer)
- Bright red with open sores
- Uniformly smooth and moisturized
Correct answer: Pale, scaly, and with accumulated dead skin cells
Following cast removal, the skin typically appears pale, scaly, and covered with accumulated dead cells due to lack of exposure and normal desquamation under the cast.
Question 5: A cast that becomes wet and begins to soften should be:
- Dried with a heat gun set to high
- Reinforced with additional layers of the same wet material
- Replaced with a new cast after skin care (Correct answer)
- Left to dry on its own over 48 hours
Correct answer: Replaced with a new cast after skin care
A wet, softened cast loses its structural integrity and must be removed, the skin assessed and cared for, and a new cast applied.
Question 6: Which technique helps prevent skin maceration when padding a cast?
- Using wet padding directly against the skin
- Applying excessive amounts of stockinette
- Ensuring padding is smooth without wrinkles or ridges (Correct answer)
- Omitting padding over bony prominences
Correct answer: Ensuring padding is smooth without wrinkles or ridges
Smooth, wrinkle-free padding distributes pressure evenly and prevents focal pressure points that cause skin breakdown and maceration.
Question 7: The cast spreader tool used during bivalving is inserted into the cut to:
- Cut through the underlying padding
- Pry the two halves apart to decompress the limb (Correct answer)
- Measure the compartment pressure
- Guide the cast saw along the correct line
Correct answer: Pry the two halves apart to decompress the limb
The cast spreader is inserted into the bivalve cuts to gently pry the halves apart, widening the cast to relieve constrictive pressure.
OTC Orthopaedic Technologist Certified Cast Complications and Removal 4
A patient reports inserting a pencil inside their cast to scratch an itch and now has increased pain at that site.
The FIRST priority is: