Page 332 - Orthopedic Casts and Splints2

Performance Steps
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. Remove heels of each hand from splint when contours of the wrist and forearm have been
shaped and splint is cured.
18. Mold splint to elbow.
a. Place the heel of one hand on the anterior aspect of the elbow.
b. Place the heel of the other hand on the posterior aspect of the elbow.
c. Apply firm and gradual pressure at the elbow and maintain the elbow in correct position.
d. Remove heels of each hand from splint when contours of the elbow have been shaped and
splint is cured.

19. Check range of motion ( ROM ) of phalanges/ shoulder.
a. Have patient extend and flex fingers.
b. Have patient abduct and adduct shoulder.
20. Check alignment of injured wrist/elbow with goniometer.
a. Place the stationary arm of the goniometer parallel to the forearm.
b. Place the moving arm of the goniometer vertically, bisecting the lateral side of the 5th
phalange (little finger)
c. Place the protractor of the goniometer on the ulnar styloid.
d. The wrist is measured between 0-15 degrees of dorsal extension.
NOTE: If wrist is not within 0-15 degrees of dorsal extension, ulnar or radial deviation are present,
remove splint and go to step 10.
e. Go to step 13 for elbow measurement.
NOTE: If elbow is not 90 degrees of flexion or wrist is not between 0-15 degrees, remove splint and go to
step 11.
21. Check splint dimensions.
a. The distal edge of the splint is at the base of the MCPJ's.
b. The volar edge of the splint is flush with the DPC.
c. The proximal edge of the splint rests 2 inches distal to the axilla region or at the base of the
deltoid muscle
22. 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.
23. Clean plaster 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.
24. Fit patient with a sling.
NOTE: Consideration for applying a sling include elderly patient's, severity of fractures (e.g. Colles',
Smith's, Bennett's), patient's comfort, physician's or technician's preference.

25. Give patient verbal and written instructions on cast care.
a. Instruct 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 the Emergency Room (ER).
b. Present patient with cast care booklet or ( written instruction )
c. Instruct patient to keep arm elevated and flex and extend uninjured fingers to increase
circulation in the hand

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