Page 228 - Orthopedic Casts and Splints2

Performance Steps

6. Gather equipment to include scissors, thermometer, goniometer, ruler 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, box of plaster reinforcement sheets, box of alcohol pads and damp towel. Open and
remove (3) plaster rolls from their 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).
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 and for privacy.
b. Locate the fibula head.
CAUTION: The peroneal nerve is located on the lateral side of the knee. If the nerve is constricted it
could die and cause drop foot( known as nerve palsy ). This is an irreversible condition. Measure 1 finger
breadth below the fibula head and provide extra padding to the area to prevent further injury to the
patient.
c. Place the uninjured ankle at a 90 degree angle to the tibia.
d. Place the knee between 0-15 degrees of flexion.
e. Measure 1 inch distal to the tips of the toes to 4 inches distal to the groin.
NOTE: Instruments of measurement may vary ( e. g. tape measure, plaster sheet or webril ).
NOTE: Patient may assist technician by placing the edge of the ruler at the inguinal region, placing the
width of their hand in the same manner, or the technician can locate the buttock crease and use webril
to obtain distance needed. The technician may also use their own technique
f. Place measured webril on work station/cart.
g. Roll out second layer and place on the middle of the previous padding.
h. Layer the padding 2-4 thickness.
9. Prepare plaster splint.
a. Open box of 5 x 30 inch plaster reinforcement sheets. Remove and unwrap package. Locate
edge of six stacks and remove from package. Place on work cart/station.
NOTE: 15-20 plaster sheets are needed for all lower extremity splints.

NOTE: 5 x 30 inch plaster splints are usually stacked in increments of five from the manufacturer. If not
pre stacked, count out 20-30 layers of plaster sheets.

NOTE: The technician may choose to use 6 inch plaster rolls.
b. Place stack of sheets on padding, cut excess as needed.
10. Measure patient's injured ankle w/ goniometer.
a. Position the patient's injured ankle at a 90 degree angle to the tibia.
NOTE: There are several ways to maintain the ankle at a 90 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 parallel to the tibia.
c. Place the moving arm of the goniometer in line with the lateral edge of the heel and the head
of the fifth metatarsal.
d. Place the protractor of the goniometer on the lateral malleolus.

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