Page 100 - Orthopedic Casts and Splints2

Performance Steps
NOTE: Family member (s), nursing staff, orthopaedic technician or finger trap stand can be used to
assist in positioning the patient's arm.
23. Apply 2nd plaster/fiberglass roll( repeat steps 19-20).

24. Measure injured elbow with goniometer.
a. Place the stationary arm of the goniometer horizontally , bisecting the middle of the
humerus and deltoid muscle.
b. Place the moving arm of the goniometer vertically , bisecting the middle of the forearm and
the 2nd and 3rd phalanges.
c. Place the protractor of the goniometer on the olecranon( elbow), forming a 90 degree angle.
d. The goniometer should measure 90 degrees of flexion
NOTE: If elbow is not measured at 90 degrees of flexion, the forearm pronated or supinated, remove
the cast and go to step 8.

25. Measure patient's injured wrist w/ goniometer.
a. Place the stationary arm of the goniometer vertically, bisecting the ulnar.
b. Place the moving arm of the goniometer vertically, bisecting the 5th phalange ( pinky finger ).
c. Place the protractor of the goniometer on the ulnar styloid.
d. The goniometer should measure between 0-15 degrees of dorsal extension .
NOTE: If wrist is not measured between 0-15 degrees of dorsal extension degrees the forearm is in
pronation or supination, remove the cast and go to step 8.

26. Mold the cast( interosseous).
NOTE: The interosseous mold is used to prevent movement of the injured wrist in the cast and promote
fracture healing.
a. Place the heel of one hand on the volar aspect of the distal wrist.
b. Place the heel of the second hand on the dorsal aspect of the distal wrist.
c. Squeeze the heels of each hand together
d. Apply firm and gradual pressure beginning at the wrist and progress up the forearm.
CAUTION: Excessive pressure may result in further patient injury. Talk to the patient while performing
this procedure ( e. g. How do you feel?, Is the pressure too much ? )
e. Maintain patient's wrist in correct position.
f. Remove hands from cast when contours of the wrist and forearm have been shaped and the
cast is cured.
NOTE: All casts require a mold. Crooked casts equal straight bones.

27. Mold the cast( bicipital).
NOTE: The bicipital mold is used to prevent movement of the humerus in the cast and promote
fracture healing.
a. Place the palm of one hand on the biceps muscle.
b. Place the palm of the 2nd hand on the triceps muscle.
c. Press palms together and conform the plaster/fiberglass to the upper arm( hold for 5- 30
seconds) or until plaster/fiberglass begins to cure.

28. Apply 3rd plaster/fiberglass roll( repeat steps 19-20 )
29. Trim proximal and distal edges of cast.
a. Cut the outside edge of the cast padding.
b. Pull down the cast padding and stockinette.
CAUTION: The finished edge of the cast should end proximal to the base of the thumb to avoid radial
nerve
30. Check range of motion ( ROM ) of phalanges and thumb.
NOTE: Patient should freely be able to extend and flex fingers and touch thumb to all fingers.
31. Check cast dimensions.
a. The cast rests at the DPC.

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