Page 322 - Orthopedic Casts and Splints2

Performance Steps
a. Open box of 5 x 30 plaster sheets. Remove and unwrap package. . Locate edge of one stack
and remove from package.
NOTE: 5 x 30 plaster splints are usually stacked in increments of five from the manufacturer. If not pre
stacked, count out five layers.
b. Position the patient's elbow at a 90 degree angle to upper torso.
NOTE: Family members, nursing staff, orthopaedic technician or finger traps can be used to assist in
positioning the patient's arm.
c. Place distal end of plaster stack on the lateral aspect of the mid forearm and have patient or
assistant hold the distal end. Simultaneously bring the proximal end 2 inches distal to the axilla
or resting on the base of the deltoid muscle. Fold down the proximal end, cut off excess and
place stack on work cart/station for later use.
11. 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: A 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 stockinet on the injured arm from 1 inch distal to the tip of the thumb, to the axilla region.
NOTE: Rolling the stockinette on promotes a better fit.
e. Pinch the stockinette at the base of the thumb and cubitum area and make a 1/2 cut at a 45
degree angle.
NOTE: An alternative and authorized method is to cut the stockinette prior to application.
f. Place patient thumb through pre cut hole and smooth out stockinette.
12. Apply finger traps to fingers on injured hand ( if not used go to step 13 ).
NOTE: Use of finger traps may be required based on patient's inability to maintain arm/wrist in the correct
position, there is no assistance available, and fracture reduction is needed.
a. Place patient in supine position on the bed.
b. Place injured arm at a 90 degree angle to the upper torso and smooth out wrinkles in the
stockinette.
c. With one hand, grasp patient's injured hand and abduct from upper torso.
d. With 2nd hand, grasp finger trap set and place individual finger traps on fourth and fifth
phalange past the MCPJ's.
13. Measure patient's injured wrist w/ 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 index finger and thumb in opposition to one another.
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 ligaments.
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 .
14. Measure injured elbow with goniometer.
a. Place the stationary arm of the goniometer vertically , bisecting the middle of the humerus and
deltoid
b. Place the moving arm of the goniometer horizontally , bisecting the middle of the forearm.
c. Place the protractor of the goniometer on the olecranon( elbow), forming a 90 degree angle.
d. Set elbow until the goniometer measures 90 degrees of flexion

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