Page 116 - Orthopedic Casts and Splints2

Performance Steps

11. Apply finger traps to fingers on injured hand ( if not used go to step 12 ).
NOTE: Use of finger traps may be required based on patient's inability to maintain arm/wrist in the
correct position, there is no assistance available, and fracture reduction is needed.
a. Place patient supine on the bed.
b. Place injured arm at a 90 degree angle to the upper torso and smooth out wrinkles in the
stockinette.
c. With one hand, grasp patient's injured hand and abduct from upper torso.
d. With 2nd hand, grasp finger trap set and place individual finger traps onto fourth and fifth
phalange past the MCPJ's.

12. 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 forearm and the 2nd and 3rd
phalanges.
c. Place the protractor of the goniometer on the olecranon( elbow).
d. The goniometer should measure 90 degrees of flexion.
NOTE: If elbow is not measured at 90 degrees of flexion, the wrist is not between 0-15 degrees of
dorsal extension, the forearm is in pronation or supination repeat step 12 until elbow and wrist are
measured at correct angle.

13. Apply cast padding (webril) to forearm.
CAUTION: If the cast padding is wrinkled it must be removed and new padding applied. Wrinkled
padding can cause pressure sores which can lead to ulcers
a. Hold with one hand.
b. With 2nd hand unroll the webril 1/2 -1 inch and grasp edge with index and middle finger .
c. Place the edge of the webril 1 inch distal to the ulnar styloid and begin wrapping around the
forearm two rotations.
NOTE: The webril application is started at the base of the ulnar styloid to provide an anchor and extra
padding to the ulnar styloid.

CAUTION: Keep the cast padding on the extremity throughout the application to avoid circulation
compromise of the patient's hand/fingers.
d. Continue back up the forearm, figure of eight around the elbow and ending 1/2 inch
proximal to the edge of the stockinette.
NOTE: Wrap the cast padding in an overlapping figure of eights over the cubitum space. This will
assist in reducing wrinkles and provide the supracondylar with additional padding.
e. With each turn overlap the webril by 1/2- 1/4 from the previous wrap. The top of the webril
should bisect the middle of then previous layer covering up the shallow line and present
evenly applied padding.
NOTE: The cast padding can be cut or torn (horizontally ) when wrapping around the elbow to provide a
better fit. The technician preference will determine which technique to use.
14. Prepare casting materials.
a. If using fiberglass casting materials go to steps 15, 16 and 17
b. If using plaster casting materials go to step 18.
15. Place fiberglass casting gloves on hands.
CAUTION: The use of fiberglass casting gloves are mandatory to prevent the technician from receiving
chemical burns while using fiberglass casting materials

16. Open fiberglass casting package and go to step 18.
NOTE: Open one fiberglass package at a time. As the fiberglass roll comes in contact with the air, the
roll will start to cure and harden.
17. Apply 1st plaster/ fiberglass roll.

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