Page 289 - Orthopedic Casts and Splints2

Performance Steps
d. Place sheet next to injured arm to obtain sheet length, the DPC and thenar muscle contour .
NOTE: To increase patient cleanliness the sheet does not have to rest on the hand/forearm.
e. Draw a diagonal line on the plaster sheet that matches with the DPC of patient's hand.
NOTE: The diagonal cut facilitates free ROM of the fingers (extension and flexion).
f. Draw a curved line(half moon shape) on the plaster sheet that matches with the outer border
of the thenar muscle on the patient's hand
NOTE: The half moon pattern enables the thenar muscle to be observable and the thumb to adduct to all
fingers promoting free range of motion (ROM)
g. Place sheet on stack , cut the outlined patterns and excess length for all sheets, and place on
work cart/station for later use.
NOTE: Discard excess material in the trash receptacle.
10. Prepare aluminum splint.
a. Place aluminum splint next to uninjured arm to obtain splint length.
NOTE: The splint should extend 2 inches distal to the finger tips
b. Cut measured length and place on work cart/station for later use.
NOTE: Discard excess material in the trash receptacle.

11. Apply stockinette to patient's injured arm.
a. Place patient's injured elbow on the orthopaedic bump at a 45 degree angle to the upper
torso.
b. Hold open the sides of the stockinette.
c. Instruct patient to place injured hand into the opening.
d. Roll stockinet on the injured arm 1 inch distal to the MCPJ's to the cubitum space( bend of
elbow).
NOTE: Rolling the stockinette on promotes a better fit.
e. Pinch the stockinette at the base of the thumb and make a 1/2 inch cut at a 45 degree angle.
NOTE: An alternative and authorized method is to cut the stockinette prior to application.
f. Place patient thumb through pre cut hole and smooth out stockinette.
12. Apply finger traps to fingers on injured hand ( if not used go to step 12 ).
NOTE: Use of finger traps may be required based on patient's inability to maintain arm/wrist in the
correct position, there is no assistance available, and fracture reduction is needed.
a. Place patient in supine position on the bed.
b. Place injured arm at a 90 degree angle to the upper torso and smooth out wrinkles in the
stockinette.
c. With one hand, grasp patient's injured hand and abduct from upper torso.
d. With 2nd hand, grasp finger trap set and place individual finger traps onto fourth and fifth
phalange past the MCPJ's.
13. Measure patient's injured wrist with goniometer.
NOTE: All hand casts are applied absent of pronation, supination, radial, or ulnar deviation unless
directed by physician.
a. Place the patient's index finger and thumb in opposition to one another.
NOTE: Placing the thumb and forefinger in opposition to one another assist the patient in maintaining
wrist in neutral position. This is commonly referred to as the can of coke position.
b. Place the stationary arm of the goniometer in a vertically, bisecting the forearm.
c. Place the moving arm of the goniometer in a vertically bisecting the lateral side of the 5th
phalange ( pinky finger)
d. Place the protractor of the goniometer on the ulnar styloid.
e. Set wrist until the goniometer measures 0-15 degrees of dorsal extension.
14. Apply cast padding( webril) to injured wrist/forearm
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 vertical with one hand.

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