Page 75 - Orthopedic Casting Manual

1.1 UE Anatomy Landmarks for

Casting

Key Anatomic al Landmar ks for Proper Casting

Accurate identific ation of anatomic al landmar ks is cr itic al for ensur ing proper c ast applic ation. In the shoulder
region, the acromion and coracoid processes are p alp able mar kers that guide ar m positioning dur ing
immobilization. At the elbow, the medial and lateral epicondyles, along with the olecranon process, provide
reference points for maintaining cor rect joint alignment. For the fore ar m, the ulnar border ser ves as a guide for
p adding placement to prevent pressure sores, while the radial st yloid indic ates the distal ex tent of immobilization.

In the wr ist and hand, the anatomic al snuffbox is a crucial landmar k for assessing sc aphoid injur ies, and the
thenar and hypothenar eminences ensure functional hand positioning within the c ast. Proper identific ation and
preser vation of these landmar ks are essential to prevent complic ations and maintain functionalit y.

Neurovascular Structures to Avoid During Casting

Careful consideration of neurovascular anatomy is necessar y to avoid iatrogenic complic ations. The radial ner ve,
which wraps around the humerus at the spiral groove, is vulnerable to compression and c an resul t in wr ist drop if
improper ly managed LStanitski, 2017M. The ulnar ner ve, loc ated poster ior to the medial epicondyle and within
Guyonʼs c anal at the wr ist, requires adequate p adding to prevent “cubital tunnel syndrome. ”Similar ly, the median
ner ve, which travels through the c ar p al tunnel, is at r isk for compression-related complic ations, such as c ar p al
tunnel syndrome.

The brachial ar ter y, the main blood supply to the fore ar m and hand, must remain unobstructed to prevent
ischemia. I t is p ar ticular ly susceptible to compression at the elbow and should be monitored for signs of
comp ar tment syndrome LGelber man & Menon, 1980M. The radial and ulnar ar ter ies, p alp able at the wr ist, are
essential for maintaining per fusion in the hand. Additionally, c are must be taken to avoid constr iction of the
cephalic and b asilic veins and to preser ve lymphatic drainage, as these are vital for preventing swelling and
venous thrombosis in immobilized are as.