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A Prospective Randomized Crossover Study On The Comparison Of Cotton Vs Waterproof Cast Liners
Phillip Tomas Guillen, MD; Corey B. Fuller, MD; Montri D. Wongworawat, MD; Barth Bishop Riedel, MD
Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, CA

Introduction: Many fractures are regularly treated with closed reduction and casting to maintain alignment during fracture and ligament healing. Although Gore-Tex-based Procel cast liner (waterproof) has been compared to cotton liner and shown to be superior in the context of comfort variables and objective assessments, the Gore-Tex has been known for its difficult application and high costs. The purpose of this study is to compare newer generation waterproof liners from BSN Medical, DeltaDry, with traditional cotton liner. It is the first study to compare waterproof liner and cotton liner in a crossover model, allowing patients to swim in the pool with the cast and compare this new product with traditional cotton liner.

Materials & Methods: Twenty patients (ages 7-30) with upper extremity injuries were randomized to a waterproof-liner or cotton-liner casts made of fiberglass. Patients would switch cast-liners halfway between their treatments to fulfill crossover criteria. All fractures were within a 2-week period from original incident. Mean number of casting weeks was 4.6. At each clinic visit, patients and physicians completed questionnaires evaluating comfort and skin condition, respectively. They were also asked which cast-liner they preferred at the end of the study.

Results: Only one patient lost alignment and had to be manipulated; this occurred after being in a cotton-lining cast. There were no unscheduled cast changes. The waterproof –liner group had better scores for sweat (P= 0.01), odor (P= 0.04), and overall physician score (P=0.02). There was no significant difference in weight, itch, pain, irritation, fit and overall comfort, however seventy five percent of patients preferred waterproof casting to the cotton liner.

Conclusion: To our knowledge this is the first study to evaluate and compare comfort and effectiveness of cast liners in a randomized crossover clinical trial with this newer generation waterproof liner. In addition it is the first to allow patients to swim in a pool even with above elbow waterproof casts. When used for upper extremity injuries, waterproof cast liners, compared with cotton cast liners, had better sweat, odor and overall physician scores. The waterproof liners allow patients to rinse casts daily without risking skin maceration, rashes, or ulceration and the majority of patients prefer waterproof to cotton liner.

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