Page 298 - Orthopedic Casts and Splints2

Performance Steps
NOTE: Alternate method may be used.
b. With opposite hand unroll the plaster or fiberglass 1/2-1 inch and grasp edge with thumb, index
and middle fingers.
NOTE: Placing the thumb under the forward edge of the roll can also be used.
c. Place the plaster or fiberglass roll in bucket of tepid water and remove when bubbles cease
to rise.
CAUTION: Removing the casting material when bubbles are present ensures dry spots will be visible
during application. Dry spots cause integrity break down of the cast.
d. Squeeze the roll together(do not wring the roll).
NOTE: To evenly distribute the water and prevent telescoping of the roll during application gently
squeeze the roll inward.
e. Place the edge of the casting material on the ulnar styloid and begin wrapping around the wrist
two rotations to secure the edge .
NOTE: The cast is most susceptible to losing strength in the palm region. Therefore, a twisting or cut
method is authorized.

The Twisting method: As the roll is pushed through the palm pinch the sides of the plaster roll together
(not recommended for fiberglass) twist and evenly space the casting material on the webril. Smooth out
with volar side of fingers. The twisting method provides strength to the cast .

The CUT method: As the roll is pushed through the palm make a horizontal cut to the proximal edge of
the plaster/fiberglass roll and smooth out with volar aspect of fingers or palm. The cutting method
provides cast cosmetics. Each technician may have their own preference to these methods.
f. Continue through the palm, around the 1st and 2nd phalanges back up the forearm ending 1/2
inch proximal to the 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.
17. 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.
18. Apply reinforcement splint to index and middle phalanges.
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 around the 1st and 2nd phalanges.
d. Laminate splint on cast.
e. Maintain patient's wrist between 0-15 degrees of dorsal extension and 1st and 2nd phalanges
between 7-90 degrees of flexion. (repeat step 11).

19. Apply 2nd plaster/fiberglass roll( repeat steps 16-17 ).
20. Mold casting material to forearm/wrist .
NOTE. The mold to the wrist and forearm is called the interosseous mold. 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 each hand together.

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