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Subject: The Short Arm Cast
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Cast material: fiberglass or plaster, two 2-, 3-, or 4-inch rolls based on patient size
Stockinette: cotton or for waterproof casts—synthetic (3M Synthetic Cast Stockinette)
Cast padding: Cotton (BSN Specialist Cotton Cast Padding) or either synthetic cast padding (3M Scotchcast Wet or Dry Cast Padding or cast liner (Procel–Gore Cast Liner) for waterproof casts
Cast saw with vacuum attachment
A cut-resistant plastic strip (De-Flex Protective Strip) that provides protection from cuts and burns from cast saws during cast removal (optional if standard padding used)
Colles fracture (nondisplaced or after reduction)
Nondisplaced metacarpal fractures
Torus (buckle) or greenstick fracture of the distal radius
Nondisplaced or suspected scaphoid fracture (refer if more than 1 mm of displacement)
Clinically suspected scaphoid fracture with negative initial x-ray
Unfamiliarity with appropriate methods or techniques
Fractures best managed by specialty referral or surgical reduction or intervention
Improperly functioning equipment (e.g., cast saw)
Infection in tissues to be covered by a cast
PITFALL: Do not use too much padding, because this makes the cast loose.
PITFALL: Do not stretch the padding, because it will cause the padding and subsequent cast to be too tight.
PITFALL: Some extra padding should be applied over bony prominences to avoid injury under the cast. An extra roll over the ulnar styloid can avoid problems at this site.
PITFALL: Never use hot water, which can cause an excess thermochemical reaction and extremely rapid setting of the cast material. The cast material should never be wrung out.
PITFALL: Apply the cast material while keeping the roll flat against the patient. This is like unrolling carpet with the bulk of the cast roll in your palm away from the patient. Reversing this necessitates shifting the roll more from hand to hand and also tends to cause too much tension as the roll is unwound by pulling away from the patient.
PITFALL: If the cast material creates a sharp edge at the base of the thumb, trim the edge with bandage scissors or the cast saw.
PITFALL: The most common mistake made by novice physicians is to apply the cast to the metacarpophalangeal joints. All fingers need to be able to flex 90 degrees, and this means that the cast should end well short of the metacarpophalangeal joints.
PITFALL: A poorly molded cast will not immobilize the area appropriately and can apply undue pressure at the wrong areas.
PITFALL: Use broad surfaces of your hands to mold the cast. Do not use the fingertips to mold the cast because this can leave dents and pressure points to the underlying structures.
PITFALL: Cast liner is much easier to cut through than standard padding, causing burns and skin trauma. If a cutting strip was not placed, the manufacturer sells a flexible strip that can be slid under the cast and maneuvered under the path of the saw blade to protect the skin with cast removal.
Ischemia to the casted body part as a result of swelling of the extremity or the cast being applied to tightly
Pressure ulcers due to a poorly padded or poorly fitting cast, especially at bony prominences
Skin maceration if the cast gets wet and is not thoroughly dried out
Skin damage from the patient inserting foreign objects into the cast or attempting to modify the cast
Breakage of the cast as a result of misuse or inadequate structural strength as a result of inadequate overlapping of cast tape
Failure to immobilize the area as a result of a poorly fitting cast
Consider using a waterproof cast for ease of care and cleanliness.
Active children may be harder on a cast, requiring earlier replacement if worn or damaged.
Children are often frightened by the loud noise and vibration of the cast saw, so warning them and demonstrating against the practitioner’s palm that the saw is not intended to cut skin can be helpful.
DePuy OrthoTech, Tracy, CA. Web site: http://www.depuy.com
Ray-Tek Inc. Fracture Management Supplies. Web site: http://www.ray-tek.com
3M Health Care, St. Paul, MN. Phone: 1-888-364-3577. Web site: http://www.3M.com/healthcare
W. L. Gore & Associates, Flagstaff, AZ. Phone: 1-800-528-8763. Web site: http://www.goremedical.com