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VOLUME 1: Short Arm Cast Application Considerations Dangers & Complications Step-by-Step Application Instructions Cast Removal Summary Disclaimer

Application Considerations (Casting is “ART”) To achieve its function, the finished cast must “fit” like a glove and be the appropriate “dimensions” as determined by the injury. The artist must understand what he or she is trying to create. Every step has a purpose. The artist must understand and be able to control the materials he or she is using.

Dangers & Complications The unyielding nature of rigid casting materials leads to two potential serious dangers: Pressure Constriction

Dangers & Complications Pressure Special attention must be paid to bony prominences and superficial peripheral nerves by applying extra padding to these areas. Care must be taken when molding the cast to prevent the indention of the material and the creation of a pressure point.

Dangers & Complications Constriction From Without – resulting from the improper application of the casting material (wrapping too tight). From Within – resulting from excessive swelling that occurs after cast application.

Dangers & Complications Prevention – “RICE” R – Rest I – Ice C – Compression E – Elevation Rest to the injured part is accomplished by the splint or cast and reduced patient activity level. Ice can be applied directly on the splint or cast and is the responsibility of the patient or caregiver. Compression is accomplished by the splint or cast. Elevation is when the injured body part is higher than the heart and is the responsibility of patient or caregiver.

Dangers & Complications Warning Signs – 4 P’s Pain Pallor (pulseless) Poikilothermia (cool) Paresthesia / Paralysis It is critical to listen to your patient. If you are not confident interpreting a complaint, ask someone who is. When treating a fresh injury where swelling is anticipated, it is good practice to have the patient come back the next day for a circulation check.

Step-by-Step Application Instructions (Short Arm Cast)

Gather your supplies. Stockinet Casting Tape Padding Gloves Always gather all of your supplies before you begin the procedure. The water temperature should be cool or standing room temperature. You should also have bandage scissors, which are not shown in this slide. Stockinet Casting Tape Padding Gloves

Cut stockinet to assure “fit” and “dimensions.” Functional End (Single Layer) Comfort End (Double Layer) When selecting the stockinet, you begin to impact the “fit” and “dimensions” of the cast. The distal end of the cast is usually designed for function while the proximal end is designed for comfort. The functional requirements dictate the design. You want the stockinet to fit snugly around the wrist without restricting venous return at the proximal end. Two-inch stockinet is the appropriate size for most of the population. The stockinet must be cut long enough to accommodate shortening that takes place when the stockinet is stretched widthwise. You also need to have extra stockinet at the proximal end so you can create a double layer for comfort when the stockinet is rolled back over the casting material before the final wrap. The hole for the thumb should be cut approximately four finger breadths from the distal end of the stockinet and just large enough to comfortably fit the thumb through. Rolling up the stockinet into a donut starting, at the proximal end and continuing to the thumb hole, will help facilitate application.

Apply a double layer of stockinet to the thumb to fold back over the fiberglass before the final wrap. Cut a piece of one-inch stockinet approximately twice the length of the thumb. Make a lengthwise cut about one third the length of the stockinet at one end. Slip the stockinet onto the thumb with slit at the web-space. Roll back the stockinet to create a double layer.

Apply the padding so that the “dimensions” are established and the “fit” is retained. Two Fingers from the Crease of the Elbow Distal Palmar Crease The padding becomes singularly the most important part of the cast application because it will establish both the dimensions and the fit. With properly applied padding, you simply have to stay within the margins that have been established when applying the casting material and just lay the casting tape on the padding to retain the fit. There is no need to apply tension when applying the casting tape. Two layers of padding is sufficient except over bony prominences, where more will be needed, or, more, if an excessive amount of swelling is anticipated.

Begin wrapping spirally without exposing the roll to water. Put on your gloves. Remove the casting tape from the foil pouch and place the empty pouch on the counter with your supplies. This will provide a place to set the roll when you are ready to turn back the stockinet. Begin wrapping at the wrist, moving immediately to the ulnar border of the distal palmar crease. Remember the dimensions have been created with the padding. Continue around the back of the hand and stop when you get to the web-space.

Before passing through the web-space, cut the casting tape to avoid material build-up. With the tips of your scissors pointing distally, cut at a 45-degree angle across the casting tape with the tips aiming down to the point between the thumb and index finger. The cut should extend to within ½-inch of the edge of the casting tape. The cut edges can then be folded under to bury the cut edge. Lay the material down along the margin of the distal palmar crease that has been established with the cast padding.

Wrap a second time around the hand and through the web-space, cutting as before. Repeat this cutting technique when you arrive back at the web-space, folding the edges under as before.

Proceed wrapping up the arm, overlapping by one-half. After your second pass through the web-space, start wrapping up the arm spirally, overlapping by one-half until you reach the proximal border of the cast padding.

When you reach the proximal end Because the roll has not been dipped in water, there will be enough time to let it sit on the foil pouch while you roll back the stockinet. When you reach the proximal end of the cast, cut off the remaining roll and place it on the foil pouch.

Roll back the stockinet distally, proximally, and around the thumb. Take care when you are rolling back the stockinet to eliminate all wrinkles and establish your margin distally just behind the distal palmar crease.

Complete one final pass through the web-space Dip the remaining roll in water and begin wrapping from the proximal end covering the edge of the rolled back stockinet. Complete one final pass through the web-space using the cut technique and covering all edges of the rolled back stockinet. After completing the final pass through the web-space, cut off any extra casting tape just proximal to the thumb in the middle of the volar side of the wrist. Wet your gloves and smooth the entire cast. This will give the finished cast a smoother surface. Begin molding with your flattened palms and extended fingers. Care should be taken NOT to cause indentions in the cast by squeezing with your fingers. The cast should be molded to accurately replicate the hand and wrist in a neutral and functional position. The wrist should look flat as you view it laterally and the casting tape should be molded into the palm. Smooth and mold to finish the cast.

Cast Removal Follow normal safety precautions for use of a power tool. Always use a sharp blade for cutting efficiency. The blade should be kept perpendicular to cast surface. The blade should penetrate straight down through the casting material and then be brought out. This should be done repeatedly for the length of the cut.

Summary Understand the potential dangers and complications before you begin. The “fit” and “dimensions” are established with the stockinet, padding and proper molding. Understand how to control the materials you use so you stay in control of the process. Everything you do should have a purpose. Practice – Practice – Practice.

Disclaimer The information provided on this CD is general medical information and not medical advice. The treating physician must use his or her professional judgment in selecting proper treatment and is responsible for the appropriate application of casts and splints.

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