Prakash Chandran: When a child has an injury or break or needs casting to correct a deformity, it can be a lot for families to take in. Cast care advice for families is the topic in today's podcast. And it's part of our podcast series, Pediatric Specialty Care Spotlight, provided by Shriners Children's Chicago. I'm your host, Prakash Chandran. And today, I invite you to listen with our guest, Gerald Cotton, an orthopedic technologist and cast technician at Shriner' Children's Chicago. Gerald, thank you so much for joining us today. I really appreciate your time. I just had a high level question before we get into it. Typically, what do children come into the hospital for that require them getting a cast?

Gerald Cotton: Okay. Typically, children come into Shriners Children's Chicago for musculoskeletal disorders as well as fracture management, which is fractures of the bones.

Prakash Chandran: Okay, that makes a lot of sense. So when a child comes in for one of those reasons, what can they expect when getting a cast?

Gerald Cotton: Well, they can expect treatment from our orthopedic technologist here, which have over 62 years of experience. We're nationally board-certified technologists and we're highly skilled.

Prakash Chandran: So for the lay people that are out there, they may not necessarily understand about how a cast is made or put together. Can you at a high level explain that for us?

Gerald Cotton: Yeah. Well, typically, there are three types of casts that we use. We use the fiberglass casts, which is radiolucent, which means you can see through it. And we also use a plaster cast. And there's a third cast that we use. It's called soft cast that we use. It's kind of rubbery, and we use that on a lot of our musculoskeletal disorders, like what we refer to as club feet. And these casts can be removed by the parent if the correction that we have made changes, like the cast slips. So the parents are able to remove this cast at home instead of going to an emergency room. So those are the three types of materials that we use when we're casting for musculoskeletal disorders or fractures.

Prakash Chandran: All right. Understood. So how do you determine which of the three casts to use?

Gerald Cotton: That's the determination that our orthopedic surgeons here at Shriners Children's Chicago would make. They would determine what would be the best material that would be used for this child's injury or disorder.

Prakash Chandran: Now, is it fair to say, and this is largely because of my own personal experience, that the majority of the time people are seeing the white plaster cast, like that is what's used most of the time?

Gerald Cotton: Actually, it is not. Majority of the time we'll use the fiberglass cast due to the fact that it's what we refer to as radioluscent so that when they go and take an x-ray, you can see through it. Secondly, it doesn't take as long as a plaster cast to dry. A plaster cast can take up to three days, whereas the fiberglass cast is dry in like 30 minutes and it's stronger than a plaster cast, so there are chances of them having to return because of damage to the cast.

Prakash Chandran: Wow. Things have changed since I was young. You know, we always used to see those plaster casts and everyone would sign them. I guess people have to use Sharpies on these fiberglass ones today, huh?

Gerald Cotton: Yes. And another thing, the plaster cast is much heavier than the fiberglass cast.

Prakash Chandran: Okay. So regardless of the type of cast that is applied, what can parents expect when the child wears it at home?

Gerald Cotton: Well, when they wear it at home, Again, if it's swelling, we ask them to keep it elevated. When they're going to shower, we usually will recommend that they put it in a plastic bag and face towel around the opening at the top and we'll place like two rubber bands. What it does is it prevents water from running in. If the water does make it past the first rubber band, it gets caught in the towel, then we ask them to remove those rubber bands right after they shower, because rubber bands constrict the blood.

Prakash Chandran: Can you talk at a high level about some of the questions that parents ask you about casts?

Gerald Cotton: Well, a lot of parents actually, when they come in, they're really unfamiliar with, one, the type of material that we're using or the different casts that we make. And again, the doctor would kind of determine what type of cast or what type of material that would be used, and we would determine a lot of times the best way to apply those casts. So we have a number of casts. It just depends on which type of cast is going to be applied to that child.

Prakash Chandran: So let's say the child wears the cast for awhile, they are at the point where they're ready to get it off. Do you have recommendations around how parents can prepare a child for getting the cast off?

Gerald Cotton: We do use a saw when we remove a cast. So sometimes what we will recommend is that the parents turn on a vacuum cleaner, because the cast saw makes a noise similar to the vacuum cleaner. And that way, because we deal with a lot of small children, so that'll kind of get them used to hearing that noise so that they're not excited. We do use earphones for the children to muffle some of the noise. If it's a club feet cast, then a lot of times the doctor, because again, this is that soft cast, the parents can remove that cast the night before and wash the child prior to coming in. But plaster casts, fiberglass casts, those have to be removed with that cast saw here at the hospital.

Prakash Chandran: Now, one question that I've always had is, you know, when you put a cast on, that skin obviously gets covered by the cast for an extended period of time. Are there any recommendations around helping protect or moisturize the skin before and after the cast is removed?

Gerald Cotton: Well, we recommend moisturizing the skin after the cast is removed. It's not really a good idea to moisturize the skin before, because sometimes it could kind of gum up under the cast. I think one of the main concerns for the children is that when we do apply casts, be it be the fiberglass, the plaster or the soft cast, that material gives off what we call exotherm, and it's a heat. So they need to be prepared that they're going to feel this warmth. So that's a major thing for the children. We apply a cotton padding and a stockinette over the leg and then we put the material on.

Prakash Chandran: Okay. So, you know, just as we start to close here, I know a lot of parents might be listening to this and, broadly, they just want to keep their child comfortable given the situation that their child is wearing this thing that is kind of restrictive and it's new to them. Do you have any advice around how parents can help their children feel comfortable as they have to wear the cast?

Gerald Cotton: Well, I think that the parents have to sit down and kind of talk to them about the procedure that's going to occur. And as they come in, sometimes we'll talk to them and explain things to the parent as well as to the child.

Prakash Chandran: So along the lines of keeping the child comfortable, I know that a lot of parents might do some research and try to get a waterproof cast. I know that's something that I've seen on the internet before. What are your thoughts around that?

Gerald Cotton: Well, my thoughts on the waterproof cast, there are incidents that you can use a waterproof cast. If it's a short arm cast where the arms are going to be straight, and it's really possible to drain that cast, you know, okay. If it's a long arm cast or where there's going to be a band in the cast, I really don't recommend it due to the fact that the skin is a biological Band-Aid. And if the skin is saturated with water, it can break that skin down. So a lot of parents will look on the internet and they'll say, "Hey, this is what I want." But if it's my child, I would just keep the cast clean and dry. And that way we know that there's not going to be any problems.

Prakash Chandran: Gerald, is there anything else that you would like to share with our audience today before we close?

Gerald Cotton: You know, when they come here to Shriners Children's Chicago, they can expect some of the best treatment in the world. We have very good doctors. Again, the technologists here are all board-certified and they're school-trained and you don't get that everywhere. So our knowledge is immense.

Prakash Chandran: Well, Gerald, thank you so much for your time today. I truly appreciate it.

Gerald Cotton: Oh, you're welcome, sir.

Prakash Chandran: That was Gerald Cotton, an orthopedic technologist and cast technician at Shriners Children's Chicago. If you'd like to make an appointment or for more information on the amazing care at Shriners Children's Chicago, you can visit shrinerschicago.org or call 773-622-5400. Thanks so much for listening. This has been at Pediatric Specialty Care Spotlight with Shriners Children's Chicago. I'm your host, Prakash Chandran. Thanks so much, and we'll talk next time.