Page 271 - Orthopedic Casts and Splints2

Performance Steps
c. Place stack of ( 5) plaster sheets next to the measured length , cut off excess amount and
place on work cart/station.
NOTE: Discard excess material in the trash receptacle.

10. Prepare 2nd plaster reinforcement splint for use at the femoral condyles.
NOTE: The plaster reinforcement splints( flanges ) are designed to assist the cast in limiting rotation
of the tibia/ fibula and redirecting the stress placed on the fracture site to the patella tendon.
a. Locate edge of one stack .
b. Locate the femoral condyles on the lateral/medial side of the knee.
c. Place sheet on the lateral side of the femoral condyle.
d. Draw a horse shoe line on the plaster sheet that matches with the medial femoral condyle.
e. Place the sheet on the medial side of the femoral condyle.
f. Draw a horse shoe line on the plaster sheet that matches with the lateral femoral condyle.
g. Cut outlined pattern for all sheets. Place on work cart/station for later use.
11. Apply stockinette to injured leg.
a. Drape a privacy pad/sheet over the patient's lap.
b. Hold open the sides of the stockinette.
c. Instruct patient to place injured foot in the opening.
d. Roll stockinette on injured ankle/leg from 1 inch distal to the toes to 3 inches proximal to the
patella.
NOTE: The patient may assist in rolling up the stockinette past the patella.
e. Fold and cut the stockinette at the bend of the ankle.
NOTE: Cutting the stockinette reduces the chance of pressure sores developing from the stockinette
rubbing or bunching up under the cast.
f. Smooth out the stockinette
12. Measure patient's injured ankle w/ goniometer.
NOTE: All short leg casts( SLC) are applied in the neutral position (90 degrees dorsiflexion) absent
of inversion and eversion, unless otherwise indicated by the physician' order.
a. Position the patient's injured ankle at a 90 degree angle to the tibia.
NOTE: There are several ways to maintain a 90 degree angle. The patient could maintain the position,
nursing assistant or family member can assist, a T stand or thigh holder could be used. It is the
technician preference.
b. Place the stationary arm of the goniometer parallel to the fibula.
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.
e. Set the ankle until the goniometer measures 90 degrees of dorsiflexion.
13. Apply cast padding (webril).
CAUTION: The webril must be removed if wrinkles appear . Wrinkled padding can cause pressure
sores, which can lead to ulcers.
a. Hold webril with one hand.
b. With 2nd hand unroll the webril 1/2 - 1 inch and grasp edge with index, middle finger and
thumb.
c. Place the edge of the webril at the distal aspect of the tibia/fibula and begin wrapping
around the malleolus two rotations.
NOTE: The technician may also start 1 inch distal to the stockinette edge.

NOTE: The webril application is started at the distal aspect of the tibia/fibula to provide an anchor and
extra padding to the malleolus.

CAUTION: Keep the cast padding on the extremity throughout the application to avoid circulation
compromise of the patient's toes.

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