Page 315 - Orthopedic Casts and Splints2

Performance Steps
NOTE: Discard excess material in the trash receptacle.

10. Apply stockinette to patient's injured arm.
a. Place patient's injured elbow on the orthopaedic bump.
b. Hold open the sides of the stockinette.
NOTE: 1 inch stockinette can be applied to the thumb in addition to the hand and arm stockinette.
c. Instruct patient to place injured hand in the opening of the stockinette.
d. Roll the stockinette on the injured arm from the cubitum space( bend of elbow) to one inch
distal to the thumb.
NOTE: Rolling the stockinette on promotes a better fit.
e. Pinch the stockinette at the base of the thumb and make a 1/2 inch cut to the stockinette.
f. Place patient's thumb through pre cut hole and smooth out stockinette.
11. Measure patient's injured wrist with goniometer.
NOTE: All hand casts are applied absent of pronation, supination, radial, or ulnar deviation unless
directed by physician's order.
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 index finger and thumb in opposition to one another(Refer to figure 3-x)
NOTE: Placing the thumb and forefinger in opposition to one another assist the patient in maintaining
wrist in neutral position and reduces the strain on the thumb ligament.
c. Place the stationary arm of the goniometer vertically, bisecting the forearm.
d. Place the moving arm of the goniometer vertically, 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 .

12. Apply cast padding( webril) to injured thumb, wrist and forearm(Refer to figure 3-x).
a. Hold webril with one hand.
b. With 2nd hand unroll the webril 1/2 - 1inch and grasp edge with index and middle finger .
c. 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. The webril application can also be started at the distal edge of the thumb.

CAUTION: Keep the cast padding on the extremity throughout the application to avoid circulation
compromise of the patient's hand/fingers.
d. Continue through the palm, around the thumb, back up the forearm and ending 1 inch distal
to the stockinette edge.
e. 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.
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.
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