Skin-related complications of casting in children: a systematic review

Casting is the most common treatment for pediatric fractures and neuromuscular-skeletal disorders such as cerebral palsy, developmental or neuromuscular dysplasia of the hip, Perthes disease, and scoliosis. Few studies determine the most common causes of skin complications from casting. This study aims to provide a quantitative breakdown of specific skin complications across cast types and offer practical solutions. A literature review, last searched on 17 October 2024, following PRISMA guidelines, identified all cases of pediatric skin-related casting complications and categorized them by cause. These were analyzed to determine the significant causes of complications. Chi-square tests determined whether a given complication accounted for a significant proportion of all complications. AMSTAR 2 was used for an overall appraisal of the review process, and ROBINS-I and RoB 2 were used at the individual study level. Nineteen articles with a total of 11 464 patients were reviewed. There were 599 skin-related complications, comprising 77.99% of all casting complications. The most common skin complications were pressure ulcers (23.7%), unspecified skin irritations (20.4%), wet cast (18.9%), and cast rubbing/fitting issues (18.5%) (P < 0.001). Unspecified etiology skin irritation and wet cast comprise 39.2% of all skin-related casting complications in children; hence, education on cast-covering techniques is essential to decrease these complications. Pressure ulcers and cast-related rubbing/fitting issues account for 42.2% of complications and are addressed by proper molding and padding around pressure points to produce better-fitting casts. In short, a substantial proportion of skin-related casting complications are potentially preventable with proper casting technique and by avoiding wet casts.