Page 184 - Orthopedic Casts and Splints2

Performance Steps
CAUTION: To reduce cast indentations, which can cause pressure sores to the patient's skin under the
cast, keep finger tips off the cast during the application and molding process.

CAUTION: The patient must be asked throughout the casting process if they feel pressure sores or
hot spots developing under the cast. hot spots are areas within the cast that continue to stay warm and
may even progress to hot. If sores or hot spots are developing the cast must be removed
immediately
b. Rub the cast material in the direction it was applied.
NOTE: Laminating the cast material fills in the pores which assist it providing strength to the cast.
c. Conform the casting material to the body contours.
d. Continue rubbing the cast until the tone /texture changes from a glossy/creamy color to a dull
white color.
NOTE: The dull white color represents the cast beginning to cure.
18. Apply reinforcement splints to the cast .
NOTE: The reinforcement splints are used to strengthen and support the cast. Splints may be
applied vertically, horizontally or by physician's order.
a. Place each splint individually in tepid water, wait for bubbles to subside and remove from
water.
b. Squeeze each splint together to remove excess water.
c. Place reinforcement splints to the posterior(sacral area), on the anterior/posterior aspects of
the iliac crests and on the posterior aspect of the arm.
d. Laminate splints to the cast.
NOTE: Instruct the patient to remain in the same position as directed. A technician or family member
may assist the patient.
19. Apply 3rd and 4th plaster/fiberglass rolls( repeat steps 16-17)

20. 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. Apply firm and gradual pressure beginning at the ac joint and progress down the arm and
torso.
e. 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 ? )
f. Remove hands from cast when contours of the torso have been shaped to the body and cast
is cured.

21. Secure wooden bar (strut) to the medial aspect of the mid forearm and anterior iliac crest region.
NOTE: A wooden bar from an old/unusable crutch or metal bar can be used .
a. Measure distance between mid forearm and torso with tape measure or ruler.
NOTE: Physician's order will determine whether the injured arm is adducted or abducted from the
torso.
b. Place strut next to the measured length obtained in 21 a and cut off excess amount with cast
saw.
CAUTION: For safety purposes do not cut the strut in front of the patient.
c. Place strut end at the anterior iliac crest.
d. With casting material wrap a figure eight around the end of the strut and cast.
e. Continue wrapping the casting material across the strut and laminate .
f. Place opposite strut end on the medial aspect of forearm.

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