Page 106 - Orthopedic Casts and Splints2

Performance Steps
c. Place stack of ( 5) plaster sheets next to the measured length , cut off excess amount and
place on work cart/station.
NOTE: Discard excess material in the trash receptacle.

10. Prepare plaster reinforcement splint for use at the femoral condyles.
NOTE: The plaster reinforcement splints are designed to assist in reinforcing the cast at the knee
region..
a. Locate edge of two stacks .
b. Measure on the medial and lateral sides of the leg 4 inches distal to the groin crossing the
knee and ending at the distal edge of the calf muscle.
NOTE: The splints can also be applied on the medical/lateral side of the cast. The application of the
splint is technician preference.
c. Place (2)stacks of ( 5) plaster sheets next to the measured length , cut off excess amount and
place on work cart/station.
NOTE: Discard excess material in the trash receptacle.

11. Apply stockinette to patient's injured leg.
a. Hold open sides of the stockinette.
b. Instruct patient to place injured foot in the opening of the stockinette.
c. Roll stockinette on injured ankle/leg from 3 inches proximal to the greater trochanter to 2
inches distal to the phalanges.
NOTE: The patient may assist in rolling the stockinette past the greater trochanter
d. Pinch the stockinette at the base of the tibia/fibula and back of knee and cut at a 45 degree
angle.
NOTE: Cutting the stockinette reduces the chance of pressure sores developing from excessive
stockinette rubbing or bunching up under the cast.
12. Position the patient's injured ankle at a 90 degree angle to the tibia.
NOTE: There are several ways to obtain a 90 degree angle. The patient could maintain the position, a
nursing personnel or family member can assist, a T stand, or thigh stand could be used. It is the
technician preference.
a. Instruct patient to dorsiflex the foot.
NOTE: Many patient's will not know the meaning of dorsiflex. Instruct the patient to pull their toes
towards their head or have the patient simulate squishing a bug with their heel. Either technique will
assist the patient in maintaining the ankle at 90 degrees. Each technician may use their own
techniques.
b. Align the 2nd and 3rd phalanges with the knee.
NOTE: Aligning the phalanges with the knee reduces eversion or inversion of the foot.
c. Have nursing personnel grasp the metatarsals of the patient's injured foot under the
stockinette.
NOTE: Grasping the metatarsals under the stockinette, reduces the chance the foot will be inverted or
everted.
d. Have nursing personnel place opposite forearm under the patient's injured knee.
NOTE: Bracing the forearm under the knee reduces muscle strain for the patient, assists with proper
ankle angle and knee flexion.

13. Measure patient's injured ankle w/ goniometer.
NOTE: The ankle is always positioned at a 90 degree angle( dorsiflexion), absent of inversion and
eversion, unless otherwise indicated by physician's order. The knee is flexed between 0-15 degrees,
unless otherwise indicated by physician's order.
a. Place the stationary arm of the goniometer parallel to the fibula.
b. Place the moving arm of the goniometer bisecting, the lateral edge of the heel and the head of
the fifth metatarsal.
c. Place the protractor of the goniometer on the lateral malleolus.
d. Set the ankle until the goniometer measures 90 degrees of dorsiflexion.

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