Page 273 - Orthopedic Casts and Splints2

Performance Steps
c. Place splint on the cast beginning from the web space of the toes to 1 finger width below the
fibular notch/head or 3 inches distal to the popliteal space and laminate.
d. Maintain patient's ankle at 90 degree dorsiflexion until splint adheres to cast material.

20. Apply 2nd plaster/fiberglass roll ( repeat steps 17-18 ).
21. Mold the cast material to the lower leg.
a. Place palm of hand on the gastrocnemius muscle and apply pressure. Hold until contours
takes shape.
NOTE: A flat board can also be used to mold the cast to the gastrocnemius.
b. Place lateral aspect of both thumbs ( forming a triangle) on the tibia and apply even pressure
up/down the tibia. Hold until contours take shape.
c. Place the web spacing of the thumb and index finger(C mold) to the distal aspect of the
patella and apply pressure. Hold until contours take shape.
NOTE: The molding process may take several minutes. Ensure the cast is well molded before
continuing. The cast is well molded when the malleolus, tibia, plantar arch achilles, calcaneus,
gastrocnemius and the femoral condyles are visible.
d. Place heel of hands on the femoral condyles. Hold until contours take shape.
e. Place palm of hand on plantar arch. Hold until contour take shape.
f. Place palm of hand on calcaneus. Hold until contour take shape.
22. Trim cast to fit patient.
a. Draw a curved line ( half moon shape ) on the cast that matches with the outer border of the
previous molded femoral condyles.
b. With cast saw trim the outline around the femoral condyles and posteriorly to the level
opposite of the tibial tuberosity.
c. With cast saw trim distal aspect of the cast for toes visibility and ROM .
d. Remove excess casting material and disregard in trash receptacle.
e. Fold and tack down the webril and stockinette.
NOTE: Tape or plaster remnants can be used to tack down the stockinette.
23. Check range of motion ( ROM ) of knee and toes.
a. Have patient extend and flex knee and toes.
b. Cut webril at the distal and proximal edges and the posterior aspect of the knee.

24. Check alignment of ankle with goniometer.
a. Place the stationary arm of the goniometer bisecting the 5th metatarsal .
b. Place the moving arm of the goniometer bisecting the tibia.
c. Place the protractor of the goniometer on the lateral malleolus.
NOTE: If the ankle is not at 90 degrees, inverted or everted remove cast and go to step 12.

25. Check cast dimensions.
a. The proximal cast edge is one finger breath distal to the fibula notch.
b. The distal cast edge is in line with the web spacing on the posterior aspect of the foot.
c. The anterior portion of the cast rests on the patella tendon.

26. Apply and laminate splint to femoral condyles.
a. Place plaster reinforcement splint in water. Wait for bubbles to cease to rise and remove
splint from water.
b. With second hand place index and middle finger on either side of the splint and squeegee
out excess water.
c. Place reinforcement splint on the lateral side of the cast in line with the outer border of the
femoral condyle and laminate.
d. Follow a-c for the medial side splint application.
27. Apply 3 rd and 4 the plaster/fiberglass roll ( repeat steps 17-18 )
NOTE: A fan fold technique may be used to reinforce the flanges.
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