Page 324 - Orthopedic Casts and Splints2

Performance Steps
NOTE: The cast is most susceptible to losing strength in the palm region. Therefore, a cut or twisting
method is authorized.

The Twisting method: As the roll is pushed through the palm pinch the sides of the plaster roll together
(not recommended for fiberglass) and twist . Evenly space the casting material on the webril and
smooth out with volar side of fingers. The twisting method provides strength to the cast .

The Cut method: As the roll is pushed through the palm make a horizontal cut to the proximal edge of
the plaster/fiberglass roll and smooth out with volar aspect of fingers or palm.The cutting method
provides cast cosmetics. Each technician may have their own preference to these methods.
f. Continue through the palm around the thumb ending 1/2 inch distal to the edge of the webril,
back up the forearm, figure of eight around the elbow, ending 1/2 inch proximal to the edge of
the webril
g. Overlap the plaster/fiberglass by 1/2 or 1/4 the previous wrap. The top of the plaster/fiberglass
should bisect the middle of the previous layer and present an evenly applied cast.
NOTE: Depending on the size of the patient's forearm and biceps region more than two rolls may be
needed for the initial roll. Begin extra roll where the previous roll left off.
20. Laminate the casting material.
a. Place palm of each hand on the cast.
CAUTION: To reduce cast indentations, which can cause pressure sore to the patient's skin under the
cast, keep finger tips off the cast during application and molding process. If the patient feels pressure
sore or hot spots developing under the cast, the cast must be removed immediately.
b. Rub the cast material in the direction it was applied.
NOTE: Laminating the cast material fills in the pores which assist it providing strength to the cast.
c. Continue rubbing the cast until the tone/texture changes from a glossy/creamy color to a dull
white color
21. Apply reinforcement splint to the radial aspect of cast.
NOTE: The reinforcement splint is used to strengthen and support the cast.
a. Place the splint in tepid water, wait for bubbles to subside and remove splint from water.
b. Squeeze the splint together to eliminate excess water.
c. Place reinforcement splint on the radial side of the cast around the thumb.
d. Laminate splint on cast.
e. Maintain patient's wrist between 0-15 degrees of dorsal extension and thumb in opposition to
the index finger.
NOTE: Place patient's thumb and index finger in opposition to one another.

22. Apply plaster reinforcement splint. to the posterior aspect of the cast .
NOTE: Plaster reinforcement splint is used to strengthen and support the cast. Upper extremity fiberglass
casts do not require a splint, due to the strength of the fiberglass casting material.
a. Place plaster splint in bucket of taped water, wait for bubbles to subside and remove splint
from water.
b. Squeeze the plaster splint together.
c. Extend plaster splint and squeegee out excess water.
NOTE: Place index and middle fingers on either side of the splint and move fingers down the splint.
d. Place reinforcement splint centered and on the posterior side of the elbow extending from mid
forearm to 1/2 inch distal to the webril edge.
e. Smooth out splint and continue to laminate.
f. Maintain patient's elbow at 90 degrees of flexion.
NOTE: Family member (s), nursing staff, orthopaedic technician or finger traps can be used to assist in
positioning the patient's arm.

23. Apply 2nd plaster/fiberglass roll( repeat steps 19-20).
24. Measure injured elbow with goniometer.

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