Page 167 - Orthopedic Casts and Splints2

Performance Steps
c. Place reinforcement splints to the posterior(sacral area), medial and lateral( oblique muscle
region)aspects of the cast 1 inch distal to the edge of the cast material.
d. Laminate splints to the cast.
e. Maintain patient's spine in physician order position.
NOTE: Instruct the patient to remain in the same position as directed. A technician or family member
may assist the patient.
22. Apply 3rd and 4th plaster/fiberglass rolls( repeat steps 19-20).

23. Mold the cast.
a. Place heels of each hand on iliac crests, apply firm pressure .
b. Remove hands from cast when contours of the iliac crests have been shaped and cast is
cured.
c. Apply firm and gradual pressure beginning below the axilla and progress down the torso.
CAUTION: Excessive pressure may result in further patient injury. Talk to the patient during this
procedure( e.g. How do they feel?, Is the pressure too much?)
d. Remove hands from cast when contours of the torso have been shaped to the body and cast
is cured.
24. Trim cast to fit patient.
CAUTION: Patients in the cast room are always offered and encourage to use hearing/eye protection.
Technicians must wear hearing/eye protection when removing a cast.

NOTE: Patient's are under no obligation to wear hearing and eye protection, but are told of the
consequences of not using hearing and eye protection.
a. Draw and cut the lower trimming line:
NOTE: The markings can be done by a pen, grease pencil etc.

NOTE: The cast saw along with scissors can be used to cut outlines.
(1) Draw a curved line from the symphysis pubis arch upward and then downward above
the flexion crease of the hip joint to the greater trochanter.
(2) The line is continued across the lower buttock region in a curved fashion to the
sacrococcygeal junction and is connected to the opposite trimming line.
(3) Draw a 4 inch radius outline at the diaphragm.
NOTE: Use the costal margin and navel as landmarks.
(4) With the cast saw cut the outline and place excess cast material in trash receptacle
remove towel.
(5) Fold webril and stockinette edges over the trimmed cast ends and secure with
adhesive tape.
b. Draw and cut the upper trimming line:
(1) Draw a curved line from the upper sternum, going laterally and downward to the lower
portion of the axilla and then proceed medial and upward to the lateral border of the
scapula and connect to the opposite trimming line.
(2) With the cast saw cut the outline and place excess cast material in trash receptacle.
(3) Fold webril and stockinette edges over the trimmed cast ends and secure with
adhesive tape.
25. Check range of motion ( ROM ) of shoulders and hips.
a. Have patient sit in chair from a standing position.
b. Have patient rotate shoulders.
c. Have patient rotate hips.
d. Have patient inhale and exhale to determine airway compliance.
NOTE. If patient is unable to accomplish a-d trim the cast as needed.
26. Check cast dimensions.
a. The top of the sternum is visible.

164