Anthony Walker prepares to remove a patient’s cast using the "quiet saw," a new device that is minimizing trauma for children.
(October 2010) Nine-year-old Rosemarie Webster, who plays the violin in a baroque chamber ensemble, was preparing to perform Pachabel’s Canon in an end-of-the-semester recital. A few days before the concert, she fell off a zip line on the school playground and fractured her left arm.
“It was a really bad break,” recalls her mother, Mary Lou Aleskie. “You could see the bone through the skin and she hit the growth plate,” the area of growing tissue near the ends of long bones in children that determines the length of the mature bone.
Webster was treated by Yale Medical Group orthopaedists. After the bone was set, her arm had to be immobilized for a month in a large cast that extended from her armpit to her fingers. When the big day finally arrived for Webster to have the cast removed, she found that cutting it off wasn’t the happy experience she’d imagined.
“Using that big, loud tool was traumatic,” Aleskie recalls. Webster’s reaction is not uncommon, particularly among toddlers and younger children, says Brian Smith, MD, director of pediatric orthopaedics at Yale Medical Group. “The saw creates quite a roar.”
After Webster’s first cast was removed, she needed to wear a second, smaller cast for a few more weeks. She dreaded going through the cast removal ordeal again, but, luckily for her, the second time around was a very different experience. Because the second cast was shorter and didn’t bend at the elbow, Smith was able to use a different device—a new “quiet saw.”
Yale Orthopaedics received a $4,995 grant from the Ronald McDonald House Charities of Connecticut and Western Massachusetts to buy an OrthoPediatrics Quiet Cast Removal System, which removes pediatric casts at half decibel level as the regular saw.
“The difference between the two saws was night and day,” says Aleskie. “The original instrument looked like a Hoover vacuum cleaner and stood three feet high. The quiet saw was like a rechargeable drill with a happy face on it.”
Yale was the first pediatric orthopaedic practice in Connecticut and one of the first in New England to acquire the Quiet Cast Removal System. Smith says the department is now looking to buy other child-friendly devices to reduce patient stress. “Any trauma we can minimize for children is something we would like to do,” he says.
The quiet saw is used between 50 and 75 percent of the time, depending on whether the cast is straight or angled. That number is growing as Smith and his colleagues become more familiar with the device and develop techniques that enable them to use it in more cases. The saw’s manufacturer is also exploring ways to modify the tool so it will be suitable for the vast majority of casts. “I think it won’t be too long before you’re going to see the quiet saw used almost all the time,” Smith says.
Aleskie is grateful for the efforts Smith and his team made to ease Webster’s anxiety. “Instruments like the quiet saw say that the people leading the organization care about patients beyond the mechanics of their healing,” she says. “I can’t say how much I appreciate that.”
Story by Jennifer Kaylin
Photos and video by Robert Lisak
New products make pediatric care easier
The quiet saw is just one of several new products that is either on the market or being developed to address the unique challenges of treating children with orthopaedic conditions.
Until recently, pediatric patients requiring a pin, screw, rod or plate received an adult device that had been retrofitted, often by the surgeon. Sometimes implants originally designed for dogs were used. But Brian Smith, MD, says that’s starting to change.
“Companies have stepped up with the development of new technologies,” he says, adding that the Food and Drug Administration is pushing for more child-tailored orthopaedic devices.
Yale has started using specially designed pediatric implants to treat scoliosis and some fractures. Smith’s group is also using bendable nails in children with long bone fractures. This allows doctors to avoid interference with the child’s growth plate. “If you cross the growth plate, it can affect the patient’s eventual height,” he says.
Another device Smith is looking into is the pediatric spica cast table—a table that supports the child and gives the doctor full access to the patient while wrapping a cast.
“They’re not reinventing the wheel,” he says, “but they’re coming up with updated, user-friendly accessories to make the patient more comfortable and help us do a better job.”
Yale Physicians Building
800 Howard Avenue
New Haven, CT 06519
Pediatric Specialty Center
One Long Wharf Drive
New Haven, CT 06511
Orthopaedics - Guilford
157 Goose Lane
Guilford, CT 06437
Orthopaedics - Middlebury
1579 Straits Turnpike
Middlebury, CT 06762
Orthopaedics - Milford
20 Commerce Park
Milford, CT 06460
Orthopaedics - Shelton
4 Corporate Drive
Shelton, CT 06484
The buildings are handicapped accessible.
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