Page 206 - Orthopedic Casts and Splints2

Performance Steps

6. Gather equipment to include scissors, thermometer and bucket of tepid water w/ plastic bag.
Place on work cart or station.
CAUTION: The temperature of the water must be tepid ( 70-80 degrees) to reduce further injury
(possible burns) to the patient. The technician should draw room temperature water and initially use a
thermometer to gauge water temperature.

CAUTION: The technician must change the water after each application as the residue in the cast
bucket will act as an accelerator causing the casting material to increase in heat emission.
7. Assemble materials to include webril, plaster rolls, examination gloves, hospital pad (chux), bed
sheet, sling, plaster reinforcement sheet, alcohol pads/damp towel. Open and remove (3) plaster
rolls from packages and place on work cart/station.
NOTE: Physician's order, technician's preference, availability of supplies, and/or patient's extremity size
will determine which casting material (fiberglass/plaster) will be used.
8. Measure patient's uninjured elbow w/ goniometer.
a. Place hospital pad or bed sheet on patient's lap.
NOTE: All patient's should be given a covering( e.g. chux, bed sheet) to reduce damaging their clothing
during the casting process .
b. Place work cart with orthopaedic bump at the edge of the bed.
c. Position the patient's uninjured elbow at a 90 degree angle to the upper torso.
NOTE: There are several ways to obtain a 90 degree angle. The patient could maintain the position,
nursing personnel or family member can assist. It is the technician preference.

NOTE: The long arm posterior splint ( LAPS ) is applied with elbow at 90 degrees flexion and wrist
between 0-15 dorsal extension, absent of supination and pronation, unless otherwise indicated by
physician's order..
d. Place the stationary arm of the goniometer bisecting the humerus.
e. Place the moving arm of the goniometer bisecting the 2nd and 3rd metacarpals.
f. Place the protractor of the goniometer on the olecernon process( elbow ).
g. Set the elbow until the goniometer measures 90 degrees of flexion.
9. Measure patient's uninjured wrist w/ goniometer.
a. Place the stationary arm of the goniometer bisecting the lateral aspect of the ulnar.
b. Place the moving arm of the goniometer bisecting the 5th phalange(little finger).
c. Place the protractor of the goniometer on the ulnar styloid.
d. Set the wrist until the goniometer measures between 0-15 degrees of dorsal extension.
10. Prepare cast padding ( webril) for posterior splint.
a. With the patient's uninjured arm at a 90 degree angle to the upper torso, locate the distal
palmar crease(DPC) and base of the deltoid muscle.
NOTE: The distal palmar crease( DPC )is the distal diagonal line on the volar aspect of the hand. The
deltoid muscle is at the base of the upper arm, or 2 inches from the axilla region on the lateral side.
b. Measure from the DPC to 2 inches distal to the axilla region.
c. Place measure webril on work station/cart.
d. Roll out second layer and bisect the middle of the previous padding.
e. Layer the padding 2-4 thickness.
11. Prepare cast padding for medial/lateral stirrups.
a. Measure the lateral aspect of the upper arm from base of the deltoid muscle to mid forearm.
b. Measure the medial aspect of the upper arm from the base of the deltoid muscle to mid
forearm.
NOTE: The physician may choose to use one stirrup to encompass the elbow. The measurement will be
the same.
c. Place measured webril lengths on work station/cart.
d. Roll out second layer and bisect the middle of the each previous padding.

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