Page 99 - Orthopedic Casts and Splints2

Performance Steps
e. Place the plaster or fiberglass end on the ulnar styloid and begin wrapping around the wrist
two rotations to secure the edge.
NOTE: The cast is most susceptible to losing strength in the palm region. Therefore, a twisting or cut
method is authorized.

The Twisting method: As the roll is pushed through the palm pinch the sides of the plaster roll
together (not recommended for fiberglass) twist and evenly space the casting material on the webril.
Smooth out with volar side of fingers. The twisting method provides strength to the cast .

The CUT method: As the roll is pushed through the palm make a horizontal cut to the proximal edge
of the plaster/fiberglass roll and smooth out with volar aspect of fingers or palm. The cutting method
provides cast cosmetics. Each technician may have their own preference to these methods.
f. Continue through the palm ending 1/2 inch distal to the edge of the webril, back up the
forearm, figure of eight around the elbow, ending 1/2 inch proximal to the edge of the webril
g. Overlap the plaster/fiberglass by 1/2/ or 1/4 the previous wrap. The top of the
plaster/fiberglass should bisect the middle of the previous layer covering up the shadow line
and present an evenly applied cast.
NOTE: Depending on the size of the patient's forearm and biceps region more than two rolls may be
needed for the initial roll. Begin extra roll where the previous roll left off.

20. Laminate the casting materials.
a. Place palm of each hand on the cast.
CAUTION: To reduce cast indentations, which can cause pressure sore to the patient's skin under the
cast, keep finger tips off the cast during application and molding process. If the patient feels pressure
sore 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 plaster reinforcement splint to volar aspect of cast.( if using fiberglass go to step 23 ) .
NOTE: Plaster reinforcement splint is used to strength and support the cast.
a. Place the plaster splint in bucket of tepid water, wait for bubbles to subside and remove
splint from water.
b. Squeeze the splint together to eliminate excess water.
c. Extend plaster splint and squeegee out excess water.
NOTE: Place index and middle fingers on either side of the splint and move fingers down the splint.
d. Place reinforcement splint on the volar side of the cast in line with the DPC and the outer
boarder of the thenar muscle.
e. Smooth out splint and continue to laminate.
f. Maintain patient's wrist between 0- 15 degrees of dorsal extension
NOTE: Place patient's thumb and index finger in opposition to one another.
22. Apply plaster reinforcement splint. to the posterior aspect of the cast .
NOTE: Plaster reinforcement splint is used to strength and support the cast. Upper extremity fiberglass
casts do not require a splint, due to the strength of the fiberglass casting material.
a. Place plaster splint in bucket of tepid water, wait for bubbles to subside and remove splint
from water.
b. Squeeze the plaster splint together.
c. Extend plaster splint and squeegee out excess water.
NOTE: Place index and middle fingers on either side of the splint and move fingers down the splint.
d. Place reinforcement splint centered and on the posterior side of the elbow extending from
mid forearm to 1/2 inch distal to the webril edge.
e. Smooth out splint and continue to laminate.
f. Maintain patient's elbow at 90 degrees of flexion.
96