Page 212 - Orthopedic Casts and Splints2

Performance Steps

11. Measure patient's uninjured 4th and 5th phalanges 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.
c. Place the protractor of the goniometer on the ulnar styloid.
d. Set the phalanges until the goniometer measures between 70-90 degrees of flexion.

12. Apply ulnar gutter splint to injured arm.
NOTE: Assistance( family member or nurse) may be used to secure splint to injured arm.

NOTE: The ulnar gutter splint is applied with the wrist between 0-15 degrees of dorsal extension,
absent of radial and ulnar deviation and supination and pronation and the 4th and 5th phalanges flexed
between 70-90 degrees, unless otherwise indicated by physician's order.
a. Place the plaster sheets in bucket of tepid water and remove when bubbles cease to rise.
b. Squeeze the sheets together to eliminate excess water.
NOTE: Do not wring the sheet, this will cause the roll to dry more quickly.
c. Place the plaster sheets centered and 1/2 inch from the edge of the padding .
d. Laminate plaster splint.
e. Cut the webril in line with the plaster vertical cut.
f. Fold over the edges of the padding.
g. Place additional layer of padding over folded edges.
h. Place padding between the fourth and fifth phalanges.
NOTE: Padding is placed between the phalanges to reduce maceration of the skin.
i. Tape the injured phalanges together.
NOTE: Tapping the injured phalanges reduces rotation of the phalanges when splinted.
j. Check the position of the phalanges.
CAUTION: Always position the injury and then apply the splint . Never apply the splint and then position.
This may cause further injury ( e.g. pressure sores ) to the patient.
k. Place the padded splint on the ulnar aspect of the hand covering the 4th and 5th metacarpals
and distal to the injured phalanges.
CAUTION: The 4th and 5th metacarpals must be covered circumferential by the splint to properly
immobilize the injury and prevent further injury to the patient.

13. Secure splint injured wrist forearm.
a. Hold elastic roll with one hand.
b. Place the edge of the elastic bandage on the ulnar styloid and begin wrapping around the wrist
two rotations to secure the edge .
c. Continue through the palm, around the 4th and 5th phalanges back up the forearm ending 1
inch distal to the cubitum space.
d. Secure elastic bandage with clips.
e. Tape down the elastic bandage in between the clips.
f. Remove the clips and dispose in trash receptacle.

14. Mold splint to forearm/wrist.
NOTE. The interosseous mold is used to prevent movement of the wrist in the cast and promote fracture
healing .
a. Place the heel of one hand on the volar aspect of the distal wrist.
b. Place the heel of the second hand on the dorsal aspect of the distal wrist.
c. Squeeze the heels of each hand together
d. Apply firm and gradual pressure beginning at the wrist and progress up the forearm while
maintaining the wrist in correct position.
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 ? )
e. Remove heels of each hand from splint when contours of the wrist and forearm have been
shaped and splint is cured.

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