Page 325 - Orthopedic Casts and Splints2

Performance Steps
a. Place the stationary arm of the goniometer horizontal , bisecting the middle of the humerus
and deltoid muscle.
b. Place the moving arm of the goniometer vertical , bisecting the middle of the forearm.
c. Place the protractor of the goniometer on the olecranon( elbow), forming a 90 degree angle.
d. The goniometer should measure 90 degrees of flexion.
NOTE: If elbow is not at 90 degrees of flexion, the forearm is pronated or supinated, remove the cast
and go to step 8.

25. Measure patient's injured wrist w/ goniometer.
a. Place the stationary arm of the goniometer vertically, bisecting the forearm.
b. Place the moving arm of the goniometer vertically, bisecting the 5th phalange ( pinky finger ).
c. Place the protractor of the goniometer on the ulnar styloid.
d. The goniometer should measure between 0-15 degrees of dorsal extension .
NOTE: If wrist is not between 0-15 degrees of dorsal extension, the forearm is in pronated or
supinated, remove the cast and go to step 8.

26. Mold the cast material to the wrist/forearm.
NOTE: The interosseous mold is used to prevent movement of the injured 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 together
d. Apply firm and gradual pressure beginning at the wrist and progress up the forearm.
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 hands from cast when contours of the wrist and forearm have been shaped and the
cast is cured.
NOTE: All casts require a mold. Crooked casts equal straight bones.
27. Mold the cast material to the biceps muscle.
NOTE: The bicipital mold is used to prevent movement of the humerus in the cast and promote fracture
healing.
a. Place the palm of one hand on the biceps muscle.
b. Place the palm of the 2nd hand on the triceps muscle.
c. Press palms together and conform the plaster/fiberglass to the upper arm( hold for 5- 30
seconds) or until plaster/fiberglass begins to cure.
28. Mold the cast material to the thumb.
a. Cup the injured thumb with hand.
b. Squeeze 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.
29. Apply 3rd and 4th plaster/fiberglass roll( repeat steps 19-20 )

30. Trim proximal and distal edges of cast.
a. Cut the outside edge of the cast padding.
b. Pull down the cast padding and stockinette over the edges of the cast to provide a finished
look.

31. Check range of motion ( ROM ) of phalanges .
NOTE: Patient should freely be able to extend and flex fingers.

32. Check alignment of wrist with goniometer. Go to step 25.
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