Page 108 - Orthopedic Casts and Splints2

Performance Steps
f. Continue down the foot, ending 1/2 inch distal to the edge of the webril , back up the leg,
ending 1/2 inch proximal to the edge of the webril.
g. With each turn overlap the plaster/fiberglass by 1/4 -1/2 the previous wrap. The top of the
plaster/fiberglass should bisect the middle of the previous layer and present evenly applied
casting material.
NOTE: To reduce possible constrictive edema caused by applying the plaster/fiberglass too tight, keep
the plaster/fiberglass roll on the extremity as it is applied.

19. Laminate the casting materials.
a. Place palm of each hand on the cast.
CAUTION: To reduce cast indentations, which can cause pressure sore to the patient's skin under the
cast, keep finger tips off the cast during application and molding process. If the patient feels pressure
sore or hot spots developing under the cast, the cast must be removed immediately.
b. Rub the cast material in the direction it was applied.
NOTE: Laminating the cast material fills in the pores which assist it providing strength to the cast.
c. Continue rubbing the plaster cast until the tone/texture changes from a glossy/creamy color to
a dull white color. If using fiberglass continue to laminate until the cast begins to harden.
NOTE: The dull white color indicates the plaster is beginning to cure

20. Apply reinforcement splint to posterior aspect of cast.
NOTE: The plaster reinforcement splint is used to strength and support the cast.
a. Place the splint in tepid water, wait for bubbles to subside and remove splint from water..
b. Squeeze the splint together to eliminate excess water.
c. Place reinforcement splint on the posterior side of the cast in line with the web spacing of the
foot and below the tibial tuberosity and laminate the splint.
d. Maintain patient's ankle at 90 degree dorsiflexion.
NOTE: Instruct the patient to squish a bug with their heal or bring their toes to their nose. Either technique
will assist the patient in bringing their ankle to a 90 degree angle. The technician may have their own
preference to the above techniques.
21. Apply 2nd plaster/fiberglass roll ( repeat steps 18-19 ).

22. Mold the cast material to the lower leg.
a. Place palm of hand on the gastrocnemius muscle and apply pressure. Hold until contours takes
shape.
NOTE: A flat board can also be used to mold the gastrocnemius.
b. Place lateral aspect of both thumbs ( forming a triangle) on the tibia and apply even pressure
up/down the tibia. Hold until contours take shape.
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 ? )
c. Place lateral aspect of both thumbs ( forming a c) on the malleolus and apply even pressure to
the border of the malleolus. Hold until contours take shape.
d. Remove heels of hands from the cast when contours of the ankle, tibia/fibula have been
shaped and the cast is cured.
NOTE: All casts require a mold. Crooked casts equal straight bones.
e. Have assistant remove hand from under stockinette at the patient's foot.
23. Check range of motion ( ROM ) of phalanges.
a. Have patient extend, flex toes.
b. Cut the webril at the distal, proximal edges and at the base of the MTPJ'S
CAUTION: The finished edge of the cast should end proximal to the base of the fifth MTPJ to avoid
nerve impingement.
c. Fold and tack down the webril and stockinet with casting material .

24. Check alignment of injured ankle with goniometer.
a. Place the stationary arm of the goniometer parallel to the fibula.
b. Place the moving arm of the goniometer vertical bisecting the 5th metatarsal head .

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