Page 118 - Orthopedic Casts and Splints2

Performance Steps

22. Mold the cast material to the forearm.
NOTE: The interosseous mold is used to prevent movement of the injured forearm in the cast and
promote fracture healing.
a. Place the heel of one hand on the volar aspect of the cast.
b. Place the heel of the second hand on the dorsal aspect of the cast.
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 elbow in correct position.
f. Remove heels 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.
23. Mold the cast material to upper arm.
NOTE: The bicipital mold is used to prevent movement of the elbow.
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.

24. Check range of motion ( ROM ) of wrist, phalanges and thumb.
a. Have patient rotate wrist.
NOTE: Patient should have full ROM of the wrist.
b. Have patient extend, flex fingers and touch thumb to all fingers.

25. Apply 3 rd and 4th plaster/fiberglass roll( repeat steps 18-19 )
26. Trim proximal and distal ends of cast.
a. Cut the outside edge of the cast padding.
b. Pull down the cast padding.
c. Pull down the stockinette.
d. Have patient rest injured arm on pillow to reduce muscle strain.
NOTE: Continue to trim as necessary.

27. Check cast dimensions.
a. The distal edge of the cast rests 1 inch proximal to the ulnar styloid.
b. The proximal edge of the cast is 2 inches distal to the axilla region.
c. Tape down edges of stockinette and webril .
NOTE: Adhesive tape or plaster remnants can be used to tack down the edges.

28. Apply 5th roll of plaster/fiberglass( repeat steps 18-19).
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.
29. Check patient's capillary refill.
a. Squeeze patient's fingers and nail beds will turn white
b. Release patient's fingers and nail beds will return pink
CAUTION: If capillary refill is delayed for more than 2 seconds inform physician and follow physician's
instruction.
30. 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.
31. Give patient verbal and written instruction on cast care.

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