Page 309 - Orthopedic Casts and Splints2

Performance Steps
c. Place reinforcement splint on the volar/dorsal side of the cast .
d. Laminate splint on cast.
e. Maintain patient's wrist between 0-15 degrees of dorsal extension and phalanges between
70-90 degrees of flexion.
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
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. Remove heels of each hand from cast when contours of the wrist and forearm have been
shaped and cast is cured.
21. Mold cast material to phalanges.
a. Cup the injured phalanges with hand.
b. Apply pressure to the phalanges.
c. Apply firm and gradual pressure beginning at the tip of the phalanges and progress up the
forearm while maintaining the phalanges and wrist in correct position.
d. Remove heels of each hand from cast when contours of the phalanges, wrist and forearm
have been shaped and cast is cured.
22. Check range of motion ( ROM ) of thumb and elbow.
a. Have patient extend and flex thumb.
b. Have patient extend and flex elbow.
23. Check alignment of wrist and phalanges with goniometer. Go to step 11.
NOTE: If wrist is not within 0-15 degrees of dorsal extension, ulnar or radial deviation are present or
the phalanges are not flexed between 70-90 degrees, remove cast and go to step 8.

24. Check cast dimensions.
a. The cast edge rests 1 inch distal to the tip of the phalanges
CAUTION: To avoid further injury to the patient, the finished edge of the cast should end distal to the
tip of the thumb.
b. The cast edge should rests 1 inch distal to the cubital space.
Caution: To promote full range of motion of the patient's elbow, the finished edge of the cast should
rests 1 inch distal to the cubital space.
c. Tape down edges of stockinette and webril.
25. Apply 3rd plaster roll( repeat steps 16-17 ).
NOTE: The last roll in all casting applications is commonly referred to as the beautification roll or the
money roll. Take pride in your work.

26. Check patient's capillary refill.
a. Squeeze patient's fingers and nail beds will turn white .
b. Release patient's fingers and nail beds will return pink .
CAUTION: If capillary refill is delayed for more than 2 seconds inform physician and follow physician's
instruction.

27. Clean plaster resin off patient's skin using a damp wash cloth, towel or alcohol pad.
Note: Use alcohol pad or fresh water from the faucet and not from the casting bucket .

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