Page 347 - Orthopedic Casts and Splints2

Performance Steps
a. Hold elastic roll with one hand.
b. Place the edge of the elastic bandage on the radial styloid and begin wrapping around the
wrist two rotations to secure the edge .
c. Continue through the palm, around the thumb and back down the forearm ending 1 inch distal
to the cubitum space.
d. Secure elastic bandage with clips.
e. Tape down the elastic bandage between the clips.
f. Remove the clips and dispose in trash receptacle.
13. Mold splint to thumb.
NOTE. This mold is used to prevent movement of the thumb in the splint and promote fracture healing .
a. Place hand around the thumb ( Cup mold).
b. Apply gradual pressure beginning at the tip of the thumb ,continuing down the radius.
c. Remove palm of hand from splint when contours of the thumb and wrist have been shaped
and the splint is cured.

14. Check range of motion ( ROM ) of phalanges.
a. Have patient extend and flex uninjured fingers.
b. Have patient flex and extend elbow.
15. Check alignment of injured wrist with goniometer (go to step 10 ).
NOTE: If wrist is not within 0-15 degrees of dorsal extension, the thumb is not in opposition to the
thumb, ulnar or radial deviation are present, remove splint and go to step 9 and repeat the process.
16. Check splint dimensions.
a. Proximal edge of splint is 1 inch distal to the cubitum space.
b. The edge of the splint is 1/2 inch distal to the injured tip of the thumb.
NOTE: If the splint is not distal to the injured thumb and the distal interphalange joint (DIP ) is allowed to
flex, remove splint and go to step 11.

17. 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.

18. 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 .

19. 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.

20. 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.
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
d. Instruct patient not to stick any objects down the splint, do not remove the splint, and do not
alter the cast ( e. g. cutting, removing padding ).

21. Annotate the procedure applied to patient in medical record or SF 513.
NOTE: Record the procedure applied and cast care instruction provided to the patient in patient's medical
record or Standard Form 513 and sign your name.
22. Escort patient to front desk to make a follow up appointment.
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