The Medical Science On Waterproof Casting Is Crystal Clear

Scott J. Tarantino, MD, FAAOS

1. Are you wondering if waterproof casting is safe for your patients?
2. Does waterproof casting achieve the same or better outcomes than what you are doing now?
3. Does waterproof casting make your patient’s life better?

As clinicians, these are three simple questions we all should ask ourselves when considering a change in the way we practice orthopedic medicine. If you’ve been immobilizing fractures using cotton-based casts with great success for many years or decades, I understand the hesitancy to consider a change to waterproof casting materials. However, as technology continues to move forward and evolve, our patients will start to become less and less tolerant of being in an “old-school” dry cast and be more likely to seek practices that provide modern waterproof options, like AquaCast Liner.  

The following studies done over the course of the last 30 years have evaluated different waterproof casting materials with respect to a variety of factors like skin health, odor, itching, and patient satisfaction. Some have also looked at outcomes for fracture healing, maintenance of radiographic alignment, and even return to function. The findings overall are favorable for waterproof cast materials in terms of safety, efficacy, patient satisfaction, and outcomes.

What is the published data and science?

1. Goretex Fabric as a Cast Underliner in Children (1991) — 20 patients
2. Waterproof Casts for Children’s Fractures and Sprains (2005) — 165 patients
3. A More Comfortable Cast (1993) -- 140 patients
4. A Waterproof Cast Liner Earns High Marks (1997) — 337 patients
5. Waterproof vs Cotton Cast Liners:A Randomized Prospective Comparison (2006) — 59 patients
6. A Prospective Study on the Effectiveness of Cotton vs Waterproof Cast Padding in Maintaining the Reduction of Pediatric Distal Forearm Fractures (2011) — 59 patients
7. It is not just comfort:  Waterproof Casting Increases Physical Functioning in Children with Minimally Angulated Distal Radius Fractures (2017) — 26 patients
8. Waterproof Cast Liners in Pediatric Forearm Fractures: A Randomized Trial (2013) — 105 patients

Is it safe for your patients?
The short answer is “yes”, it is safe. Based on the studies above, skin health complication rates were lower than traditional casting and were mostly minor irritation or a rash. This issue can be further minimized with education of our patients on how to properly care for the cast at home. Waterproof casts have been proven to have lower odor and less itching due to the ability to wash out any retained dry or sloughing skin—we’ve all seen (and smelled) that horribly odorous traditional cast with all the dead skin caught on the stockinette and on the arm. The patient satisfaction rates (over 98%) demonstrate that patients and/or parents are happy with their waterproof cast.  

Does it achieve the same or better outcomes than what you are doing now? Outcomes with respect to non-operatively treated fractures are mostly defined in terms of (1) radiographic healing with maintenance of alignment and (2) return to function. The studies performed to date looking at these issues have focused on pediatric forearm fractures and have shown no statistical difference in outcomes between traditional or waterproof casting.  One study even looked at 100% displaced pediatric distal forearm fractures treated with a formal closed reduction in a cast and showed no difference in alignment when a waterproof cast was used. There is also evidence that children with forearm fractures seem to return to physical function and activity more quickly when treated in a waterproof cast. It is safe to say that when used properly, waterproof casting materials like AquaCast Liner can achieve similar outcomes and perhaps allow a faster return to function.

Does it make your patient’s life better?
Patient satisfaction scores demonstrate the answer is a resounding “yes”!  Nobody I know wants to live in a cast for 4-6 weeks, but if it needs to be done, it will naturally be a more enjoyable experience if it itches less, smells less, and allows you to shower, bathe, and swim; all while giving you a better (or at least equivalent) outcome.  

As an orthopaedic surgeon, I understand the conservative nature of orthopedic surgeons and their strong will to advocate for and protect their patients. The science and the data have shown that waterproof casting materials are safe for your patients and provide equivalent radiographic and perhaps even better functional outcomes (for forearm fractures in children). AquaCast Liner will make your patient’s recovery from a fracture a little less intrusive and limiting in their life