Page 15 - Orthopedic Casts and Splints2

Performance Steps
NOTE: To increase patient cleanliness the sheet does not have to rest on the hand/forearm
e. Draw a diagonal line on the plaster sheet that matches with the DPC of patient's hand.
NOTE: The diagonal cut facilitates free ROM of the fingers (extension and flexion).
f. Draw a curved line(half moon shape) on the plaster sheet that matches with the outer
border of the thenar muscle on the patient's hand.
NOTE: The half moon pattern enables the thenar muscle to be observable and the thumb to adduct to
all fingers promoting free range of motion (ROM)
g. Place stack of (5) plaster sheets next to measured length to identify the difference, cut off
excess amount and place stack on work cart/station.
NOTE: Discard excess materials in the trash receptacle.
10. Prepare plaster reinforcement splint for the posterior aspect of cast.
a. Open box of 5 x30 plaster sheets. Remove and unwrap package from box. Locate edge of
one stack (5 thickness) and remove from package.
NOTE:5 x30 plaster sheets are usually stacked in increments of five from the manufacturer. If not pre
stacked, count out five layers of plaster splints.
b. Place distal end of plaster splint on the lateral aspect of the mid forearm and have patient
hold the distal end. Simultaneously bring the proximal end 2 inches distal to the axilla or
resting on the base of the deltoid muscle. Fold down the proximal end, cut off excess and
place stack on work cart/station for later use.
c. Have patient rest injured arm on pillow.
11. Manufacture plaster /fiberglass loop.
a. Remove (2) 4 x 15 plaster sheet from stack of plaster sheets..
b. Hold plaster sheet vertically and fold length wise.
c. Hold both ends of the plaster sheet with index fingers and thumbs and place in water.
d. Remove plaster sheet when bubbles subside .
NOTE: Hold the plaster sheet vertically , place index finger and thumb on either side and squeegee
out excess water.
e. Place sheet on working surface, smooth out sheet and drape over extra roll of webril .

12. Apply stockinette to patient's injured arm.
a. Place patient's injured elbow on the orthopaedic bump at a 90 degree angle to the upper
torso.
b. Hold open the sides of the stockinette.
c. Instruct patient to place injured hand in the stockinette opening.
d. Roll stockinet on the injured arm from the axial region to 1 inch distal to the MCPJ's .
NOTE: Rolling the stockinette on promotes a better fit.
e. Pinch the stockinette at the base of the thumb and cubitum area and make a 45 degree angle
cut .
NOTE: An alternative and authorized method is to cut the stockinette prior to application.
f. Have patient place thumb through the pre cut hole and smooth out stockinette.

13. Apply finger traps to fingers on injured hand ( if not used go to step 14 ).
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. Apply stockinette go to step 12 b-f.
c. Place injured arm at a 90 degree angle to the upper torso and smooth out wrinkles in the
stockinette.
d. With one hand, grasp patient's injured hand and abduct from upper torso.
e. With 2nd hand, grasp finger trap set and place individual finger traps onto fourth and fifth
phalange past the MCPJ's.
14. Measure patient's injured elbow/wrist w/ goniometer.

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