Page 307 - Orthopedic Casts and Splints2

Performance Steps
f. Draw a half moon line to the volar side of the plaster sheet at the base of the thenar
muscle.
g. Place sheet on stack , cut the outlined pattern and excess length for all sheets, and place
on work cart/station for later use.
NOTE: Disregard excess materials in a trash receptacle.

10. Apply stockinette to patient's injured arm.
a. Place patient's injured elbow on the orthopaedic bump.
b. Place webril( casting padding) strips between patient's fingers.
NOTE: Padding reduces chafing and skin sores from developing.
c. Hold open the sides of the stockinette.
NOTE: 1 inch stockinette can be applied to each phalanges in addition to the hand and arm
stockinette.
d. Instruct patient to place injured hand in the opening of the stockinette.
e. Roll the stockinette on the injured arm from 2 inches distal to the phalanges, 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's thumb through pre cut hole and smooth out stockinette.
11. Measure patient's injured wrist and phalanges with goniometer.
NOTE: All hand casts are applied absent of pronation, supination, radial, or ulnar deviation unless
directed by physician.
a. Position the patient's injured elbow at a 90 degree angle to upper torso.
NOTE: Family member (s), nursing staff, orthopaedic technician or finger traps can be used to assist in
positioning the patient's arm.
b. Place the patient's phalange between 70-90 degrees of flexion.
c. Place the stationary arm of the goniometer vertical, bisecting the forearm.
d. Place the moving arm of the goniometer vertical, bisecting the lateral side of the 5th phalange
( pinky 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 .
g. Set phalanges until the goniometer measures 70-90 degrees of flexion.
12. Apply cast padding( webril) to injured phalanges, wrist and forearm.
a. Place webril strips between each phalanges
b. Hold webril vertically 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 phalanges, back up the forearm and 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 and around
the thumb 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.
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