Page 281 - Orthopedic Casts and Splints2

Performance Steps
NOTE: The ankle is always positioned at a 90 degree angle( dorsiflexion), absent of inversion and
eversion, unless otherwise indicated by physician's order. The knee is flexed between 0-15 degrees,
unless otherwise indicated by physician's order.
a. Place the stationary arm of the goniometer parallel to the fibula.
b. Place the moving arm of the goniometer bisecting, the lateral edge of the heel and the head
of the fifth metatarsal.
c. Place the protractor of the goniometer on the lateral malleolus.
d. Set the ankle until the goniometer measures 90 degrees of dorsiflexion.
15. Measure injured knee with goniometer.
a. Place the stationary arm of the goniometer horizontal , bisecting the lateral aspect of the
femur.
b. Place the moving arm of the goniometer horizontal , bisecting the lateral aspect of the fibula.
c. Place the protractor of the goniometer on the lateral aspect of the knee.
d. Set knee until the goniometer measures between 0-15 degrees of flexion.
CAUTION: The patient will not be able to maintain this position. The technician may use an assistant
or other supports e.g. t stand, thigh holder.

16. Apply cast padding (webril) to patient's injured leg.
CAUTION: If the cast padding is wrinkled it must be removed and new padding applied. Wrinkled
padding can cause pressure sores which can lead to ulcers
a. Hold webril vertically 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 from the distal edge of the stockinette.

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.
d. Continue up the foot and leg, figure eight around the knee ending 1 inch distal to the edge of
the stockinette.
NOTE: The webril should end at the highest point on the medial thigh that patient comfort is allowed.
e. With each turn overlap the webril by 1/2 -1/4 the previous wrap. The top of the webril should
bisect the middle of the previous layer covering up the shallow line and present evenly
applied padding. To reduce possible constrictive edema caused by applying webril too tight,
keep the webril on the extremity as it is applied.
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 provide extra padding to prevent this condition.
17. Prepare casting materials.
a. If using plaster rolls, go to step 20
b. If using fiberglass rolls, go to step 18.

18. Place fiberglass casting gloves on hands.
CAUTION: To prevent chemical burns to the hands it is mandatory for the technician to use fiberglass
casting gloves.

NOTE: Tube of surgical lubricant can be used to keep gloves from adhering to fiberglass casting
material.
19. Open fiberglass casting package and go to step 18

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