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• Gloves (to prevent direct contact with fiberglass)
• Protective drapes (to avoid material spreading on surfaces)

Upper Extremity Casting and Splinting Techniques

Proper application of upper extremity casts and splints ensures optimal fracture stabilization, soft
tissue protection, and post-surgical healing. The choice between different casting and splinting
techniques depends on the location and severity of the injury, as well as the need for joint
immobilization or functional support. This section provides an in-depth review of commonly
used upper extremity casting and splinting techniques, their indications, and step-by-step
application procedures.

1. Short Arm Cast (SAC)

Indications:

• Distal radius and ulna fractures (non-displaced and stable fractures)
• Carpal fractures, including scaphoid fractures
• Metacarpal fractures
• Wrist sprains or post-surgical wrist stabilization

Application Steps:

1. Prepare the Limb:
o Position the forearm in neutral rotation with the wrist slightly extended (~20
degrees).
o Place the patient’s elbow at a 90-degree angle for comfort.
2. Apply Stockinette:
o Extend the stockinette 2-3 inches beyond the intended cast edges to allow for
trimming.
3. Apply Cast Padding:
o Wrap circumferentially from the metacarpal heads to just below the elbow.
o Ensure extra padding over bony prominences such as the ulnar styloid and
dorsal hand.
4. Apply Casting Material:
o Using fiberglass or plaster, wrap evenly while maintaining proper contouring
to the wrist and forearm.
5. Molding and Finishing:
o Mold the cast over the distal forearm for three-point fixation, preventing
rotation.
o Allow the cast to set before trimming excess material and ensuring free movement
of the fingers.