Page 297 - Orthopedic Casts and Splints2

Performance Steps
c. Hold open the sides of the stockinette.
d. Instruct patient to place injured hand in the opening.
e. Roll stockinette on the injured arm from 1 inch distal to the 1st and 2nd distal interphalangeal
joints to the cubitum space( bend of elbow).
NOTE: Rolling the stockinette on promotes a better fit.
f. Pinch the stockinette at the base of the thumb and make a 1/2 inch cut at a 45 degree angle.
g. Place patient thumb through pre cut hole and smooth out stockinette.

11. Measure patient's injured phalanges and 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 assists the patient in maintaining
wrist in neutral position. This is commonly referred to as the can of coke position.
b. Place the 1st and 2nd phalanges in the flexed position.
c. Place the stationary arm of the goniometer vertical, bisecting the forearm.
d. Place the moving arm of the goniometer horizontal, bisecting the lateral side of the 1st
phalange ( index finger)
e. Place the protractor of the goniometer on the ulnar styloid.
f. Set wrist until the goniometer measures 0-15 degrees of dorsal extension and set 1st and
2nd phalanges until the goniometer measures 70-90 degrees of flexion.
12. Apply cast padding( webril) to injured phalanges, wrist and forearm
a. Place cast padding between the index and middle fingers.
b. Hold webril with one hand.
c. With 2nd hand unroll the webril 1/2 - 1inch and grasp edge with index and middle finger .
d. Place the edge of the webril on the ulnar styloid and begin wrapping around the wrist two
rotations.
NOTE: The webril application is started at the wrist to provide an anchor and extra padding to the ulnar
styloid.

CAUTION: Keep the cast padding on the extremity throughout the application to avoid circulation
compromise of the patient's hand/fingers.
e. Continue through the palm, around the 1st and 2nd phalanges back up the forearm ending 1
inch distal to the stockinette edge.
f. 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.
NOTE: The cast padding can be cut or torn (horizontally ) when wrapping through the palm to provide a
better fit. The technician preference will determine which technique to use.
13. Prepare casting materials.
a. If using fiberglass casting materials go to step 14 and 15.
b. If using plaster casting materials go to step 16.

14. Place fiberglass casting gloves on hands.
Caution: The use of fiberglass casting gloves are mandatory to prevent the technician from receiving
chemical burns while applying a fiberglass cast.

15. Open fiberglass casting package and go to step 16.
NOTE: Open one fiberglass package at a time. As fiberglass roll comes in contact with the air, the roll will
start to cure and harden.
16. Apply 1st plaster/fiberglass roll.
NOTE: Examination gloves are recommended when using plaster to protect the technician's hands as
the resin in the plaster rolls may cause the skin on the hands to dry up.
a. Hold plaster or fiberglass roll with one hand.
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