Page 194 - 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. If patient feels pressure
sores or hot spots developing under the cast, 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.
23. Apply reinforcement splints to the posterior,lateral and inguinal region aspects of the cast .
NOTE: The reinforcement splints are used to strengthen and support the cast.
a. Place each splint individually into tepid water, wait for bubbles to subside and remove from
water.
b. Squeeze the splint together to remove excess water.
c. Place the reinforcement splints.
(1) The first splint is placed across the sacral area posteriorly over both hips.
(2) The second and third splints are placed medial across the pubic area and around each
hip( forming a figure of eight around the hips ).
NOTE: Laminate the splints to facilitate cast strength over the posterior aspect of the hip joints( known
as the beginners triangle).
d. Instruct assistant to maintain patient's knee and ankle in neutral position.
CAUTION: It is vital that the neutral positioning of the knee and ankle are maintained .

24. Apply 3rd and 4th plaster/fiberglass rolls( repeat steps 21-22).
25. Mold cast to body contours.
a. Place heels of hand on iliac crests, apply firm pressure .
b. Remove heels of the hands from cast when contours of the iliac crests have been shaped
and cast is cured.
c. Apply firm and gradual pressure beginning at the femoral condyle and progress down the
leg.
CAUTION: Excessive pressure may result in further patient injury. Talk to the child while performing this
procedure( e.g. how do they feel?, is the pressure too much?)
d. Remove heels of the hands from cast when contours of the torso have been shaped and cast
is cured.
26. Trim cast to fit child.
CAUTION: Patient in the cast room are always offered hearing/eye protection. Technicians must wear
hearing/eye protection during cast modification procedures. Child must wear hearing/eye protection.
a. Remove the child from the fracture or hip spica table.
NOTE: Members of the casting team will secure the child, while the other member removes the fracture
table or hip spica table.
b. Place clean sheet on bed and gently lay child on bed.
c. Draw a straight line anteriorly below the xiphoid process.
d. Draw a curved line anteriorly above the pubis symphysis arch around each leg.
NOTE: The physician may draw the lines needed.
e. The line is continued across the lower buttock region in a curved fashion above the coccyx
and is connected to the opposite trimming line.
CAUTION: The child will need to be turned for trimming the posterior aspect of the cast. All members
of the casting team will assist in moving the child as an unit.
f. Draw a 4 inch radius outline anteriorly at the abdomen.
NOTE: Use the costal margin and navel as landmarks.

Caution: Place safety goggles and hearing protection on child prior to cast removal process.
g. With the cast saw cut the previous drawn outlines, remove towel and place excess cast
material in receptacle.

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