Page 211 - Orthopedic Casts and Splints2

Performance Steps
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 (2) 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. Prepare cast padding ( webril) for ulnar splint.
a. Place work cart with orthopaedic bump at the edge of the bed.
b. 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.
c. Position the patient's uninjured elbow on the bump with arm at a 45 degree angle to the floor.
Locate the 4th and 5th phalanges.
NOTE: The 4th and 5th metacarpals ( knuckles ) are on the dorsal aspect of the hand.
d. Measure from the tips of the 4th and 5th phalanges, down the ulnar to 1 inch distal to the
cubitum space.
NOTE: Instruments of measurements may vary ( e. g. tape measure, ruler or webril)
e. Place measure webril on work station/cart.
f. Roll out second layer and bisect the middle of the previous padding.
g. Layer the padding 2-4 thickness.

9. Prepare plaster splint for the ulnar aspect of the hand.
a. Open box of 4 x 15 plaster reinforcement sheets. Remove sheets from box and unwrap
package . Peel back the edges of (10-15) sheets, remove from the stack. Place on work
cart/station.
NOTE: The technician may choose to use 3 or 4 inch plaster rolls if 4 x 12 sheets are not wide or long
enough.
b. Locate the 4th and 5th metacarpals.
c. Remove (1) plaster sheet from the stack of (10-15).
d. Place sheet on the dorsal side of the patient's hand/forearm, distal to the 4th and 5th
phalanges and covering the metacarpals.
Caution: The plaster sheets must be wide enough( to cover the 4th and 5th metacarpals circumferential)
and long enough ( distal to the injured phalanges to 1 inch to the cubitum space ) to protect the injury.
e. Hold the plaster sheet vertically and cut a 1 inch line in the middle of the plaster sheet( V cut).
NOTE: The vertical cut ( or V cut) enables the plaster to be evenly centered both on the dorsal and volar
sides of the phalanges.
f. Place sheet on stack , cut the outlined pattern and excess length for all sheets, and place on
work cart/station for later use.
NOTE: Discard all excess materials in trash receptacle.
10. Measure patient's injured wrist w/ goniometer.
a. Position the patient's injured elbow on the orthopaedic bump at a 45 degree angle to the floor
NOTE: There are several ways to obtain a 45 degree angle. The patient could maintain the position,
nursing personnel or family member can assist. It is the technician preference.
b. Place the stationary arm of the goniometer bisecting the lateral aspect of the ulnar.
c. Place the moving arm of the goniometer bisecting the 5th phalange.
d. Place the protractor of the goniometer on the ulnar styloid.
e. Set the wrist until the goniometer measures between 0-15 degrees of dorsal extension.

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