Page 291 - Orthopedic Casts and Splints2

Performance Steps
f. Continue through the palm ending 1/2 inch from the distal edge of the webril, back up the
forearm ending 1/2 inch from the proximal edge of the webril.
g. Overlap the plaster/fiberglass by 1/2 or 1/4 the previous wrap. The top of the plaster/fiberglass
should bisect the middle of the previous layer and present an evenly applied cast.
19. Laminate the casting material.
a. Place palm of each hand on the cast.
CAUTION: To reduce cast indentations, which can cause pressure sore to the patient's skin under the
cast, keep finger tips off the cast during application and molding process. If the patient feels pressure
sore or hot spots developing under the cast, the cast must be removed immediately.
b. Rub the cast material in the direction it was applied.
NOTE: Laminating the cast material fills in the pores which assist it providing strength to the cast.
c. Continue rubbing the cast until the tone/texture changes from a glossy/creamy color to a dull
white color.
20. Apply reinforcement splint to volar aspect of cast.
NOTE: The reinforcement splint is used to strengthen and support the cast.
a. Place the splint in tepid water, wait for bubbles to subside and remove splint from water.
b. Squeeze the splint together to eliminate excess water.
c. Place reinforcement splint to the volar side of the cast in line with the DPC and the outer
boarder of the thenar muscle.
d. Laminate splint on to cast.
e. Maintain patient's wrist between 0-15 degrees of dorsal extension.
NOTE: Place the patient's thumb and forefinger in opposition to one another.
21. Apply 2nd plaster/fiberglass roll( repeat steps 18 -19)

22. Mold the cast material to wrist/forearm.
NOTE. The interosseous mold is used to prevent movement of the wrist in the cast and promote fracture
healing .
a. Place the heel of one hand on the volar aspect of the distal wrist.
b. Place the heel of the second hand on the dorsal aspect of the distal wrist.
c. Squeeze the heels of the hands together
d. Apply firm and gradual pressure beginning at the wrist and progress up the forearm while
maintaining the wrist in correct position.
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 ? )
e. Maintain patient's wrist in correct position.
f. Remove heels of the hands from cast when contours of the wrist and forearm have been
shaped and cast is cured.
23. Check range of motion ( ROM ) of phalanges and thumb.
a. Have patient extend, flex fingers and touch thumb to all uninjured fingers.
b. Cut the webril at the distal, proximal edges and at the base of the thumb.
CAUTION: The finished edge of the cast should end proximal to the base of the thumb to avoid radial
nerve impingement.

24. Check alignment of wrist with goniometer.
a. Place the stationary arm of the goniometer vertically, bisecting the forearm.
b. Place the moving arm of the goniometer vertically, bisecting the lateral side of the 5th phalange
(little finger)
c. Place the protractor of the goniometer on the ulnar styloid.
d. The wrist is measured at 0-15 degrees dorsal extension.
NOTE: If wrist is not within 0-15 degrees of dorsal extension, ulnar or radial deviation are present,
remove cast and go to step 11.
25. Check cast dimensions.
288