Page 336 - Orthopedic Casts and Splints2

Performance Steps
CAUTION: The temperature of the water must be tepid ( 70-80 degrees) to reduce further injury
(possible burns) to the patient. The technician should draw room temperature water and initially use a
thermometer to gauge water temperature.

CAUTION: The technician must change the water after each application as the residue in the cast
bucket will act as an accelerator causing the casting material to increase in heat emission.
7. Assemble materials to include webril, plaster rolls, examination gloves, hospital pad (chux), bed
sheet, plaster reinforcement sheets, alcohol pads/damp towel. Open and remove (6) plaster rolls
from packages and place on work cart/station.
NOTE: Physician's order, technician's preference, availability of supplies, and/or patient's extremity size
will determine which casting material (fiberglass/plaster) will be used.
8. Prepare cast padding ( webril) for 1st splint.
a. Place hospital pad or bed sheet on patient's lap.
NOTE: All patient's should be given a covering( e.g. chux, bed sheet) to reduce damaging their clothing
during the casting process and for privacy.
b. Locate the fibula head on uninjured leg.
CAUTION: The peroneal nerve is located on the lateral side of the knee. If the nerve is constricted it
could die and cause drop foot( known as nerve palsy ). This is an irreversible condition. Measure 1
flinger width below the fibula head and provide extra padding to the area to prevent further injury to the
patient.
c. Place the uninjured ankle at a 90 degree angle to the tibia.
d. Measure from 1 inch distal to the tips of the toes to 4 inches distal to the groin region(inguinal
region).
e. Place measure webril on work station/cart.
f. Roll out second layer of padding and bisect the middle of the previous padding.
g. Layer the padding 2-4 thickness.

9. Prepare cast padding ( webril) for 2nd splint.
a. Measure from 4inches distal to the inguinal region down the medial aspect of the leg around
the ankle up the lateral aspect of the leg opposite from the start.
b. Place measured webril on work station/cart.
c. Roll out second layer and bisect the middle of the previous padding.
d. Layer the padding 2-4 thickness.
10. Prepare plaster splints.
a. Open box of 5 x 30 inch plaster reinforcement sheets. Remove and unwrap package. Locate
edge of six stacks and remove from package. Place on work cart/station.
NOTE: 4 or 6 inch plaster rolls can also be used.
b. Place (3) stack of sheets on each padding and cut excess as needed.

11. Measure patient's injured ankle w/ goniometer.
a. Position the patient's injured ankle at a 90 degree angle to the tibia.
NOTE: There are several ways to maintain the ankle at a 90 degree angle. The patient could maintain
the position, nursing personnel or family member can assist. It is the technician preference.
b. Place the stationary arm of the goniometer parallel to the tibia.
c. Place the moving arm of the goniometer in line with the lateral edge of the heel and the head
of the fifth metatarsal.
d. Place the protractor of the goniometer on the lateral malleolus.
e. Set the ankle until the goniometer measures 90 degrees of dorsiflexion.
NOTE: To assist the patient in maintaining a 90 degree angle, have the patient bend the knee ( up to 15
degrees)and point toes upward or simulate squashing a bug with the heel of their foot. This will assist in
maintaining the ankle at a 90 degree angle.

NOTE: The technician may have their own technique to assist the patient.

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