Page 88 - Orthopedic Casts and Splints2

Performance Steps
f. Draw a curved line (half moon shape) on the plaster sheet that matches with the outer
border of the thenar muscle on the patient's hand
NOTE: The half moon pattern enables the thenar muscle to be observable and the thumb to adduct to
all fingers promoting free ROM.
g. Place sheet on stack , cut the outlined patterns and excess length for all sheets, and place
on work cart/station for later use.
NOTE: Discard excess material in the trash receptacle.

10. Prepare plaster reinforcement splint for the supracondylar( olecranon) region.
NOTE: The splints( flanges) prevent rotation of the forearm.
a. Peel back the edges of (5) sheets, remove from the stack and fold in half.
b. Place sheets next to the medial and lateral supracondylar .
c. Draw a curved line(half moon shape) on the plaster sheets that matches with the medial
and lateral supracondylar of uninjured arm.
d. Cut the outlined patterns and place on work cart/station for later use.

11. Apply stockinette to patient's injured arm.
a. Place patient upper arm (triceps muscle region ) on the orthopaedic bump at a 45 degree
angle to the upper torso.
b. Hold open the sides of the stockinette.
c. Instruct patient to place injured hand in the opening of the stockinette.
d. Roll stockinette on the injured arm 1 inch distal to the MCPJ's, to 3 inches proximal to the
olecernon( elbow).
NOTE: Rolling the stockinette on promotes a better fit.
e. Pinch the stockinette at the base of the thumb and make a 1/2 inch cut at a 45 degree angle.
NOTE: An alternative and authorized method is to cut the stockinette prior to application.
f. Have patient place thumb through pre cut hole and smooth out stockinette.

12. Measure patient's injured wrist with goniometer.
NOTE: All hand casts are applied absent of pronation, supination, radial, or ulnar deviation unless
directed by physician.
a. Position the patient's elbow at a 45 degree angle to upper torso.
NOTE: Family members, nursing staff, or orthopaedic technician can be used to assist in positioning
the patient's arm.
b. Place the patient's index finger and thumb in opposition to one another.
NOTE: Placing the thumb and forefinger in opposition to one another assists the patient in maintaining
wrist in neutral position. This is commonly referred to as the can of coke position.
c. Place the stationary arm of the goniometer vertically, bisecting the ulnar.
d. Place the moving arm of the goniometer vertically, bisecting the lateral side of the 5th
phalange ( pinky finger).
e. Place the protractor of the goniometer on the ulnar styloid.
f. Set wrist until the goniometer measures 0-15 degrees of dorsal extension.

13. Apply cast padding( webril) to patient's injured arm.
CAUTION: If the cast padding is wrinkled it must be removed and new padding applied. Wrinkled
padding can cause pressure sore which can lead to ulcers.
a. Hold webril with one hand.
b. With 2nd hand unroll the webril 1/2 - 1inch and grasp edge with index and middle finger.
c. Place the edge of the webril on the ulnar styloid and begin wrapping around the wrist two
rotations.
NOTE: The webril application is started at the wrist to provide an anchor and extra padding to the
ulnar styloid.

CAUTION: Keep the cast padding on the extremity throughout the application to avoid causing
circulation compromise of the patient's hand/fingers.

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