Page 270 - Orthopedic Casts and Splints2

Performance Steps
d. Check patient's injured leg for any skin conditions ( e. g. cuts, abrasions, lacerations and skin
rashes ).
NOTE: Inform physician if conditions are present and follow physician's instructions.

5. Check patient's capillary refill.
a. Squeeze the patient's toes and nail beds turn white.
b. Release patient's toes and the nail beds will return pink .
CAUTION: If capillary refill is delayed for more than 2 seconds inform physician and follow physician
instructions.
6. Gather equipment to include: cast saw with vacuum, cast spreader, ear plugs, safety goggles,
scissors, privacy pad/sheet, orthopaedic bump, T stand (turnstile casting stand), thigh holder,
goniometer, marking pen, bucket of tepid water w/ plastic bag. Place on work cart/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 water that is room temperature 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 (cast padding), stockinette, plaster/fiberglass rolls, box of
plaster reinforcement sheets(5 x 30), package of fiberglass reinforcement splints (5 x 30),
examination gloves, fiberglass casting gloves, tube of surgical lubricant, alcohol pads/ damp
towel/wash cloth, pillow, 1 pair of crutches and cast shoe. Open and remove (5) 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 stockinette.
NOTE: Stockinette is generally used for all casts except on patients who have had recent surgery,
recently reduced fractures or as directed by the physician. Stockinette and webril (cast padding) are
forms of protection against the exothermic reaction of the casting materials. Technician and physician
preference will dictate whether stockinette is used.
a. Place the patient in the sitting position with uninjured knee and ankle at 90 degree angles to
the tibia.
NOTE: Measurements are taken on the uninjured leg to prevent further pain to the patient's inured leg.

NOTE: Instruments of measurements may vary ( e.g. tape measure, ruler, or webril ).
b. Measure from 3 inches proximal to the patella to the tips of the toes to obtain stockinette
length.
c. Pull down stockinette from stockinette container and cut measured length.
d. Roll stockinette leaving a 1-2 inch cuff at the distal edge. Place on work cart/station for later
use.

9. Prepare plaster reinforcement splint (posterior)
NOTE: The plaster reinforcement splint will be prepared for the posterior side of the injured leg/ankle.
a. Open box of 5 x 30 inch plaster reinforcement sheets. Remove and unwrap package. Locate
edge of one stack and remove from package. Place on work cart/station.
NOTE: 5 x 30 inch plaster splints are usually stacked in increments of five from the manufacturer. If
not pre stacked, count out five layers of plaster sheets.
b. Measure from 3 inches distal to the popliteal space ( or 1 finger breath from the fibula
notch/head) to the web spacing of the toes.
CAUTION: The peroneal nerve is located on the lateral side of the leg. If the nerve is constricted it
could die and cause drop foot( known as nerve palsy ). This is an irreversible condition. Locate the
fibula notch/ head and measure 1 flinger width below to prevent this condition.

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