Page 91 - Orthopedic Casts and Splints2

Performance Steps
d. Cut the outline and place excess casting materials in trash receptacle.
NOTE: Depending on the thickness and type of casting material used, the technician is authorized to
use a cast saw.
e. Cut the webril at the base of the thumb, elbow and fold down the stockinette over the edges
of the cast.
CAUTION: The finished edge of the cast should end proximal to the base of the thumb to avoid radial
nerve impingement.
f. Tape down edges of stockinette/webril.
NOTE: Adhesive tape or plaster remnants can be used.
26. Check range of motion ( ROM ) of phalanges, thumb and elbow.
a. Have patient extend, flex fingers and touch thumb to all fingers.
b. Have patient extend and flex elbow.

27. Check cast dimensions.
a. The distal edge of the cast rests at the DPC.
b. The radial aspect of the cast is proximal to the snuff box .
c. The cubitum space is visible.
d. The flanges are 3 inches proximal to the medial and lateral condylar.
NOTE: The physician's order will determine the length of the flanges.
28. Check alignment of wrist with goniometer.
a. Place the stationary arm of the goniometer vertically, bisecting the ulnar.
b. Place the moving arm of the goniometer vertically, bisecting the lateral side of the 5th
phalange ( pinky 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 cast and go to step 11.
29. Apply 3rd plaster/fiberglass roll( repeat steps 19-20).
30. Apply reinforcement splints to the supracondylar region.
a. Place the splint in tepid water, wait for bubbles to subside and remove from water.
b. Squeeze the splint together to eliminate excess water.
c. Extend the splint, place index and middle finger on either side of the splint and squeegee out
excess water.
d. Place reinforcement splint on the lateral and medial sides of the supracondylar in line with
the cut out flanges and laminate splint.
31. Apply 4th plaster roll( repeat steps 19-20 )
NOTE: The last roll in all casting applications is commonly referred to as the beautification roll or the
money roll. Take pride in your work. Technician preference will determine where the last roll is started.

32. 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.

33. Clean plaster resin 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 .

34. Give patient verbal and written instructions on cast care.
a. Instruct the 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 emergency room.
b. Present patient with cast care booklet( or written instructions).
88