Page 283 - Orthopedic Casts and Splints2

Performance Steps

25. Mold the cast material to the lower leg.
a. Place palm of hand on the gastrocnemius muscle and apply pressure. Hold until contours
take shape.
NOTE: A flat board can also be used to mold 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.
CAUTION: Excessive pressure may result in further patient injury. Talk to the patient while performing
this procedure ( e. g. How do you feel?, Is the pressure too much ? )
c. Place lateral aspect of both thumbs ( forming a c) on the malleolus and apply even pressure
to the border of the malleolus. Hold until contours take shape.
d. Remove heels of hands from the cast when contours of the ankle, tibia/fibula have been
shaped and the cast is cured.
NOTE: All casts require molding . Crooked casts equal straight bones.
26. Mold the cast material to the upper leg.
a. Quadrilateral mold: Place the palm of one hand on the lateral side of the quadrilateral
muscle.
b. Place the palm of the other hand on the medial side of the quadrilateral muscle.
c. Press palms together and conform the cast material to the leg ( hold for 5-30 seconds) or
until plaster/fiberglass begins to cure.

27. Mold the cast material to the femoral condyles.
a. Place the palm of one hand on the medial side of the femoral condyle.
b. Place the palm of one hand on the lateral side of the femoral condyle.
c. Press palms together and conform the plaster to the femoral condyles ( hold for 5-30
seconds) or until plaster/fiberglass begins to cure.
NOTE: The art of molding casting material is a continuous and ongoing procedure.
28. Check cast dimensions.
a. The web spacing is visible
b. The 5th metatarsal is visible.
c. The proximal edge of the cast is 4 inches distal to the groin region on the medial side and 3
inches proximal to the greater trochanter on the lateral side.
NOTE: Using the cast saw or scissors trim the distal /proximal edges of the cast as needed.
29. Trim the knee region of cast.
CAUTION: Prior to using a cast saw, the patient is always offered hearing and eye protection. The
technician must always wear hearing and eye protection when removing a cast.
a. With grease pencil draw two transverse(medial and lateral) circumferential lines above and
below the knee joint.
NOTE: The transverse lines are made 4 inches from the center of the femoral condyles.
b. With cast saw trim the transverse lines anteriorly and posteriorly to the level opposite of the
tibial tuberosity.
c. Remove excess casting material and disregard in trash receptacle.
d. Fold and tack down the webril and stockinette.
NOTE: Tape or plaster remnants can be used to tack down the stockinette.
e. Trim distal aspect of the cast so that all toes are visible and have full ROM.
f. Fold and tack down the webril and stockinette at the toes.
NOTE: Tape or plaster remnants can be used to tack down the stockinette.
30. Secure two knee hinges to cast.
NOTE: Physician's order will determine placement of knee hinges.
a. Place stationary arm of the first hinge on the lateral aspect of the leg bisecting the femur and
the moving arm bisecting the fibula.The rotation part of the hinge should be in line with the
middle of the patella.

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