A Pilot Study of the Wave Technique: A Safer, More Comfortable Approach to Pediatric Cast Removal

Cast removal is a routine yet potentially distressing procedure in pediatric orthopaedic care. Conventional techniques using oscillating saws can generate heat, vibration, and noise, often causing pain and anxiety in children. We herein propose a novel Wave Technique designed to minimize thermal buildup and mechanical irritation associated with cast saw use, thereby reducing procedural distress in pediatric patients.

This single-center, retrospective comparative study included 52 pediatric patients who underwent cast removal following elective orthopaedic surgery between January 2023 and June 2025. Patients were divided into 2 groups: the Intervention group (n=28) received cast removal using the Wave technique, while the Control group (n=24) underwent the traditional In-out Technique. Primary outcomes included procedural time, procedural pain, parental satisfaction, and incidence of iatrogenic skin injury. Furthermore, a simulation-based training module was administered to orthopaedic residents to assess the technique's learnability and safety profile.

The Wave Technique significantly reduced the mean procedure time by 28.5% (15.8 vs. 22.1 min, P <0.001) and lowered procedural pain scores by ∼50% ( P <0.001). Parental satisfaction was significantly higher with the Wave Technique (82.1% vs. 29.2% reporting high satisfaction, P <0.001). No major complications occurred in either group. In a simulation-based training assessment involving 30 resident physicians, the Wave Technique group had a shorter post-training procedure time (8.8 vs. 9.5 min, P =0.022) and a lower incidence of simulated skin marks compared with the In-out technique group.

The Wave Technique represents a promising and efficient advancement in pediatric cast removal, significantly reducing procedural distress, improving satisfaction, and shortening the procedure time without increasing complication rates. Its straightforward adoptability and favorable preliminary safety profile suggest potential for integration into routine clinical practice and structured residency training, though larger prospective studies are needed to confirm these findings.

Level III-therapeutic study.