Page 317 - Orthopedic Casts and Splints2

Performance Steps

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. Maintain patient's wrist in correct position.
f. 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 thumb.
a. Cup the injured thumb with hand.
b. Apply pressure to the thumb.
c. Apply firm and gradual pressure beginning at the tip of the thumb and progress up the
forearm while maintaining the thumb and wrist in correct position.
d. Remove heels of each hand from cast when contours of the thumb, wrist and forearm have
been shaped and cast is cured.
22. Check range of motion ( ROM ) of phalanges and thumb.
a. Have patient extend, flex uninjured fingers.
b. Have patient extend and flex elbow.

23. Check alignment of wrist 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 thumb is not in opposition to the index finger, remove cast and go to step 8.

24. Check cast dimensions.
a. The cast edge rests 1 inch distal to the tip of the thumb.
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 rests at the distal palmar crease.
c. 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.
d. 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 .
28. Give patient verbal and written instructions on cast care.
a. Instruct the patient to call the cast clinic should they have any concerns or questions
regarding their cast . Provide patient with a copy of the clinic hours and telephone number.
After duty hours instruct patient to report to emergency room.
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