Page 90 - Orthopedic Casts and Splints2

Performance Steps
NOTE: As the roll is pushed around the cubitum space a horizontal cut to the proximal edge of the
casting material is authorized.
20. Laminate the casting material.
a. Place palm of each hand on the cast.
CAUTION: To reduce cast indentations, which can cause pressure sores to the patient's skin under the
cast, keep finger tips off the cast during the application and molding process. If patient feels pressure
sores or hot spots developing under the cast, the cast must be removed immediately
b. Rub the cast material in the direction it was applied.
NOTE: Laminating the cast material fills in the pores which assist it providing strength to the cast.
c. Continue rubbing the cast until the tone /texture changes from a glossy/creamy color to a dull
white color.
NOTE: The dull white color represents the cast material beginning to cure.

21. Apply reinforcement splint to the volar aspect of cast .
NOTE: The reinforcement splint is used to strengthen and support the cast.
a. Place the splint in tepid water, wait for bubbles to subside and remove from water
b. Squeeze the splint together to remove excess water.
c. Place reinforcement splint to the volar side of the cast in line with the DPC and the outer
boarder of the thenar muscle .
d. Laminate the splint to the cast.
e. Maintain patient's wrist between 0-15 degrees of dorsal extension.
NOTE: Place the patient's thumb and forefinger in opposition to one another.

22. Apply 2nd plaster/fiberglass roll( repeat steps 19-20)
23. Mold the cast( interosseous).
NOTE. The interosseous mold is used to prevent movement of the 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 they feel?, is the pressure too much?)
e. Maintain the patient's wrist in correct position.
NOTE: Placing the patient's thumb and forefinger in opposition to one another assist in maintaining
wrist in neutral position.
f. Remove heels of each hand from cast when contours of the wrist and forearm have been
shaped and cast is cured.
24. Mold the cast (medial and lateral supracondylar).
NOTE: The supracondylar mold is used to prevent rotation of the forearm
a. Place the lateral aspect of the each thumb and heel on the lateral and medial condyle.
b. Apply firm and gradual pressure.
c. Maintain the patient's arm at 45 degrees of extension.
d. Remove heels of each hand from cast when contours of the condylars have been shaped
and cast is cured.
25. Trim cast to fit patient.
a. Draw a curved line( half moon shape ) on the medial and lateral side of the cast that matches
with the outer border of the supracondylar mold.
NOTE: Physician 's order will determine extension and flexion requirements of the elbow.
b. Connect the line on the anterior aspect of the cast at 1 1/2 -2 inches distal to the elbow
flexion crease.
c. Connect the line on the posterior aspect of the cast at 3 inches distal to the tip of the
olecranon.

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