Page 110 - Orthopedic Casts and Splints2

Performance Steps
d. Place reinforcement splint from medial to lateral over the knee extending above and below
the extension joint.
NOTE: The plaster reinforcement splint must extend above and below the extension joint (where the SLC
connects to the LLC).
e. Repeat steps 28 a through d for the medial side .
f. Smooth out splint and continue to laminate.
29. Apply 4th plaster/fiberglass roll( repeat step 27 )

30. Mold the cast material to the upper leg.
a. Quadrilateral mold: Place the palm of one hand on the lateral side of the quadrilateral muscle.
b. Place the palm of one hand on the medial side of the quadrilateral muscle.
c. Press palms together and conform the plaster to the leg ( hold for 5-30 seconds) or until
plaster/fiberglass begins to cure.
NOTE: Have patient place injured leg on pillow to reduce leg strain.
31. Mold the cast material to the femoral condyles.
a. Place the palm of one hand on the medial side of the femoral condyle.
b. Place the palm of one hand on the lateral side of the femoral condyle.
c. Press palms together and conform the plaster to the femoral condyles ( hold for 5-30 seconds)
or until plaster/fiberglass begins to cure.
NOTE: The art of molding casting material is a continues and ongoing procedure.

32. Check cast dimensions.
a. The distal edge of the cast rest at the web spacing of the foot.
b. The 5th metatarsal is visible.
NOTE: Having the cast edge rests below the 5th metatarsal head reduces circulation compromise.
c. The proximal edge of the cast is 4 inches distal to the groin on the medial side and 2 inches
proximal to the greater trochanter on the lateral side.

33. Apply 5th roll of plaster/fiberglass ( repeat step 27 ).
NOTE: The last roll in all casting applications is commonly referred to as the beautification roll or the
money roll. Take pride in your work.

34. Check patient's capillary refill.
a. Squeeze patient's toes and nail beds will turn white .
b. Release patient's toes and nail beds will return pink .
CAUTION: If capillary refill is delayed for more than 2 seconds inform physician and follow physician's
instruction.

35. Clean plaster resin off patient's skin using a damp wash cloth, towel or alcohol pad.
NOTE: Use alcohol pads or fresh water from the faucet and not from the casting bucket .

36. Apply a cast shoe.
NOTE: Cast shoes are available in small, medium and large sizes. The technician can determine which
size is appropriate by asking the patient their foot size or by sizing the patient's foot after casting
application.

37. Administer a crutch ambulation treatment( see task number 081-836-0041)
38. Give patient verbal and written instructions on cast care.
a. Instruct patient to call the cast clinic should they have any concerns or questions regarding
their cast. Provide patient with a copy of the clinic hours and telephone number. After duty
hours instruct patient to report to the Emergency Room.
b. Present patient with cast care booklet or ( written instruction )
c. Instruct patient to keep leg elevated and flex and extend toes to increase circulation in the foot.
d. Instruct patient not to stick anything down the cast, do not remove the cast, and do not alter the
cast ( e. g. writing or coloring the cast).

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