Page 213 - Orthopedic Casts and Splints2

Performance Steps

15. Mold the splint to the 4th and 5th metacarpals.
NOTE. This mold is used to prevent movement of the metacarpals in the splint and promote fracture
healing .
a. Place heel of hand on the dorsal aspect of the injured phalanges and apply gradual pressure.
NOTE: The physician may apply an additional mold.
b. Maintain patient's injured phalanges in correct position.
c. Remove palm of hand from splint when contours of the phalanges and wrist have been
shaped, the phalanges are between 70- 90 degrees of flexion and the splint is cured.
16. Check range of motion ( ROM ) of uninjured phalanges and elbow.
a. Have patient extend and flex non injured fingers and touch to thumb .
b. Have patient extend and flex elbow
17. Check alignment of injured wrist and phalanges with goniometer.
a. Place the stationary arm of the goniometer vertically , bisecting the forearm.
b. Place the moving arm of the goniometer vertically, bisecting the lateral side of the 5th
phalange (little finger)
c. Place the protractor of the goniometer on the ulnar styloid.
d. The wrist is measured between 0-15 degrees dorsal extension and the injured phalanges
between 70-90 degrees of flexion.
NOTE: If wrist is not within 0-15 degrees of dorsal extension, phalanges are not within 70-90 degrees of
flexion, ulnar or radial deviation are present, remove splint and go to step 11.
18. Check splint dimensions.
a. Proximal edge of splint is 1 inch distal to the cubitum space.
b. The splint is covering both the 4th and 5th metacarpals.
NOTE: If splint is not covering the 4th and 5th metacarpals, remove splint and go to step 12.
c. The distal edge of the splint is 1/2 inch distal to the injured phalanges tips.
NOTE: If the splint is not distal to the injured phalanges and the distal interphalange joint (DIP ) is allowed
to flex, remove splint and go to step 8.
19. Check patient's capillary refill.
a. Squeeze patient's fingers and nail beds will turn white .
b. Release patient's fingers and nail beds will return pink.
CAUTION: If capillary refill is delayed for more than 2 seconds inform physician and follow physician's
instruction.
20. Clean plaster off patient's skin using a damp wash cloth, towel or alcohol pad.
NOTE: Use alcohol pad or fresh water from the faucet and not from the casting bucket .
21. Fit patient with a sling.
NOTE: Consideration for applying a sling include elderly patient's, severity of fractures (e.g. Colles',
Smith's, Bennett's), patient's comfort, physician's or technician's preference.

22. Give patient verbal and written instructions on cast care.
a. Instruct patient to call the cast clinic should they have any concerns or questions regarding
their cast. Provide patient with a copy of the clinic hours and telephone number. After duty
hours instruct patient to report to the Emergency Room.
b. Present patient with cast care booklet or ( written instruction )
c. Instruct patient to keep arm elevated and flex and extend uninjured fingers to increase
circulation in the hand
d. Instruct patient not to stick any objects down the splint, do not remove the splint, and do not
alter the cast ( e. g. cutting, removing padding ).

23. Annotate the procedure applied to patient in medical record or SF 513.
NOTE: Record the procedure applied and cast care instruction provided to the patient in patient's medical
record or Standard Form 513 and sign your name.
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