Page 97 - Orthopedic Casts and Splints2

Performance Steps
NOTE: The half moon pattern enables the thenar muscle to be observable and the thumb to adduct to
all fingers promoting free range of motion (ROM)
g. Place stack of (5) plaster sheets next to measured length to identify the difference, cut off
excess amount and place on work cart/station.
NOTE: Discard excess material in the trash receptacle.

10. Prepare plaster reinforcement sheets for the posterior aspect of cast.
a. Open box of 5 x 30 plaster sheets. Remove and unwrap package. Locate edge of one
stack and remove from package.
NOTE: 5 x 30 plaster splints are usually stacked in increments of five from the manufacturer. If not pre
stacked, count out five layers.
b. Position the patient's uninjured elbow at a 90 degree angle to upper torso.
NOTE: Family members, nursing staff, orthopaedic technician or finger trap stand can be used to
assist in positioning the patient's arm.
c. Place distal end of plaster stack on the lateral aspect of the mid forearm and have patient or
assistant hold the distal end. Simultaneously bring the proximal end 2 inches distal to the
axilla or resting on the base to the deltoid muscle. Fold down the proximal end, cut off
excess and place stack on work cart/station for later use.

11. Apply stockinette to patient's injured arm.
a. Place patient's injured elbow on the orthopaedic bump.
b. Hold the sides of the stockinette open.
c. Instruct patient to place injured hand in the open end of the stockinette.
d. Roll stockinet on the injured arm from 2 inches distal to the MCPJ's to the axilla region.
NOTE: Rolling the stockinette on promotes a better fit.
e. Pinch the stockinette at the base of the thumb and cubitum area and make a 1/2 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. Apply finger traps to fingers on injured hand ( if not used go to step 13 ).
NOTE: Use of finger traps may be required based on patient's inability to maintain arm/wrist in the
correct position, there is no assistance available, and fracture reduction is needed.
a. Place patient in supine position on the bed.
b. Place injured arm at a 90 degree angle to the upper torso and smooth out wrinkles in the
stockinette.
c. With one hand, grasp patient's injured hand and abduct from upper torso.
d. With 2nd hand, grasp finger trap set and place individual finger traps on fourth and fifth
phalange past the MCPJ's.
13. Measure patient's injured wrist w/ goniometer.
NOTE: All hand casts are applied absent of pronation, supination, radial, or ulnar deviation unless
directed by physician.
a. Position the patient's injured elbow at a 90 degree angle to upper torso.
NOTE: Family member (s), nursing staff, orthopaedic technician or finger traps 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 assist 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 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.
14. Measure injured elbow with goniometer.

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