CAST

A cast holds a broken bone (fracture) in place and prevents the area around it from
moving as it heals.
Purpose
- To promote healing and early weight bearing
- To support, maintain, and protect realigned bone.
- To prevent or correct deformity.
- To immobilize
SPINE
Minerva cast
It is applied to trunk and head, with spaces cut out for face
and ears. It extends from sternum and distal rib border anterior and
across the distal rib border posteriorly.
Indications: for upper dorsal or cervical affection.
Nursing Interventions
 Always keep the cast dry and clean to prevent skin irritation
or infection.
 Instruct patient to avoid pulling the chin down to prevent increase pressure and
immobilization of the neck less effective.
 Instruct patient to eat five small meals a day rather than three large meals to ensure by
making chewing easier.
 Instruct patient to drink fluids through a straw and have regular and small intake of
fluids to keep bowel motions regular and reduce the risk of spilling fluids on the cast.
 Put a small pillow or folded towel and make sure this is no thicker than 5 cm to support
their shoulders.
 Use sponge bathing to keep clean as possible.
 Instruct patient to do not use soaps, lotions or powders in and under the cast to prevent
skin irritation.
 Use a torch to check skin under the cast at least once a day to make sure there are no
signs of skin breakdown such as ‘bruise-like’ or red discoloration.
 Check skin for signs of pressure sores, especially around the chin to prevent risk of
infection.
UPPER EXTREMITIES
Long arm cast
It is applied to arm from the hand to about lower
two thirds of arm till the level below arm pit, leaving fingers
& thumb free.
Indications
 fracture of the radius or ulna
 supracondylar fracture of the humerus.
Nursing Interventions
 Always keep the cast dry and clean to prevent skin irritation or infection.
 Check for cracks or breaks in the cast
 Rough edges can be padded to protect the skin from scratches.
 Instruct patient to do not scratch the skin under the cast by putting objects inside the
cast to prevent skin irritation or infection.
 Instruct patient to do not put powders or lotion inside the cast to prevent skin irritation.
 Cover the cast while eating to prevent food spills and crumbs from entering the cast.
 Raise the cast above heart level to decrease swelling.
 Encourage patient to move his or her fingers to promote circulation.
 Instruct patient to notify physician immediately if swelling, pain, unusual odor or
drainage coming from inside the cast, loss movement of fingers occurs.

LOWER EXTREMITIES
Long leg cast
extend from around the middle of the thigh
all the way down to the base of the toes.
Indications-
 fracture of the tibia-fibula
 Fractures around the knee
Nursing Interventions
 Always keep the cast dry and clean to prevent skin
irritation or infection.
 Check for cracks or breaks in the cast
 Rough edges can be padded to protect the skin from scratches.
 Instruct patient to do not scratch the skin under the cast by putting objects inside the
cast to prevent skin irritation or infection.
 Instruct patient to do not put powders or lotion inside the cast to prevent skin irritation.
 Cover the cast while eating to prevent food spills and crumbs from entering the cast.
 Raise the cast above heart level to decrease swelling.
 Encourage patient to move his or her toes to promote circulation.
 Instruct patient to notify physician immediately if swelling, pain, unusual odor or
drainage coming from inside the cast, loss movement of toes occurs.

POSTERIOR MOLD
Used for splinting the affected part of the body wherein there is an open wound,
inflammation, abrasion, swelling, or infection.
Purpose
 Provides immobilization
  Protects the injury
 Prevents further injury
 Decreases pain
 Allows for easy application and removal compared to a cast
 Allows for swelling better than a cast

UPPER EXTREMITIES
Long arm posterior mold
used in a variety of settings for immobilization of both
bony and soft tissue injuries to the upper extremities.
Indication
 fracture of the radius and ulna with open wound swelling and
infection.
 fracture of distal humerus
 Olecranon fracture
Materials:
 Wadding sheet
 Stockinette
 Elastic bandage
 Arm sling
 Bandage scissor
 Basin with water
Procedure:
 Apply stockinette from 2-3 inches from fingers up to auxiliary crease.
 Cut a small hole from the stockinette for the thumb.
 Measure the arm and create a template with a wadding sheet to determine the length
of the cast (measuring along the metacarpal to the supracondylar area)
 Apply the wadding sheet stretching along the wrist going proximally with a 50%
overlapping of the wadding sheet. Apply enough wadding sheet as needed to the elbow
to prevent pressure sore
 Preparing for posterior mold:
o Lay the precut template and use sheet for 3-5 layers.
o Activate the plaster of paris by dipping it in the water basin and make sure that
all bubbles have dissipated so that enough water has zipped through the plaster.
Do not squeeze and let it drain by itself.
o Lay the plaster of Paris by rolling it to the wadding sheet template, make sure it
is flat. Repeat the rolling 8-10 times.
o Cover it with the wadding sheet.
 Apply the mold and gently fit it over the arm.
  Apply the elastic bandage tightly over the mold to ensure proper fitting of the mold to
the arm. (wait for 5-10 mins for the mold to harden).
 Remove the initial elastic bandage.
 Reapply the elastic bandage a bit more loosely.
 Provide an arm sling. Apply it with an elbow that is bent at 90 degrees.
Nursing Interventions
 Keep the posterior mold dry to prevent skin irritation or infection.
 Elevate the extremity above the level of the heart to prevent swelling.
 Inspect the skin around the posterior mold.
 Advise the client to promptly notify health care provider if pain, swelling, feels tight,
sensation of tingling, burning, or tickling, weak or absence of distal pulse occur.

LOWER EXTREMITIES
Short leg posterior mold
Splinting technique that covers the posterior leg to the
plantar surface of the foot to maintain a neutral position.
Indications
 Ankle dislocations
 Ankle sprains and strains
 Achilles’ tendon rupture
 Distal tibial and fibular fracture
 Tarsal and metatarsal injuries
Materials:
 Wadding sheet
 Stockinette
 Elastic bandage
 Bandage scissor
 Basin with water
Procedure:
 Position patient in supine lying.
 Ensure patient is in comfortable position by placing a pillow under the thigh and knees.
 Take accurate measurement with a tape measure start from fingerbreadths under the
popliteal fossa until 4 inches beyond the toes.
 Cut the lower part of the stockinet.
 Apply stockinette from toes up to the knee.
 Cut out the wrinkle in the anterior area of ankle.
 Apply the wadding sheet stretching along the foot up to below of the knee.
 Preparing for posterior mold:
o Lay the precut template and use sheet for 3-5 layers.
 o Activate the plaster of paris by dipping it in the water basin and make sure that
all bubbles have dissipated so that enough water has zipped through the plaster.
Do not squeeze and let it drain by itself.
o Lay the plaster of paris by rolling it to the wadding sheet template, make sure it
is flat. Repeat the rolling 12-15 layers.
o Cover it with the wadding sheet.
o make 2 molds.
 Apply the mold and gently fit it over the leg.
 Apply again another mold in U-shaped to cover the side by side of the leg (make sure
the ankle is in 90 degree)
 Wrap it with elastic bandage, snug but not too tight.
 Turn up the stockinette by folding the end over the edge of plaster and exposed the toes
to check for circulation and turn down at the part of below the knee.
 Apply again the elastic bandage and make a turnover the edge like making a figure 8.
 Turn down the stockinette over the top and wrap again another elastic bandage from
the top up to going down.
Nursing Interventions
 Keep the posterior mold dry to prevent skin irritation or infection.
 Elevate the extremity above the level of the heart to prevent swelling.
 Encourage safety precautions (e.g., avoid walking on wet floors, watch throw rugs, be
careful with stairs).
 Advise the client to promptly notify health care provider if pain, swelling, feels tight,
sensation of tingling, burning, or tickling, weak or absence of distal pulse occur.

EXTERNAL FIXATOR
A device placed outside the skin that stabilizes bone fragments with pins or wires
connected to bars.

Purposes:
 to keep fractured bones stabilized and in alignment.
 to ensure the bones remain in an optimal position during the healing process.
UPPER EXTREMITIES
 Hoffman’s External Fixator

Indication
Indications and use of the peri-articular clamp
 Unstable extra-articular fractures of the distal radius
 Open and comminituve extra-articular fracture
 Unstable distal radial fractures with undisplaced single articular extension
 Distal radial osteotomies
Materials

Nursing Interventions
Post-operative:
 Regular active finger and wrist motion are recommended from the first post-operative
days. Weekly post-operative X-Ray control for the first three weeks is needed to check
maintenance of reduction.
 Regular pin track cleaning should be performed. Pin care – three times a day with a
mixture of hydrogen peroxide and normal saline - begins the day after surgery.
 The fixator is removed at the sixth post-operative week, provided fracture healing is
confirmed.
 Range of motion is encouraged, with particular attention to supination and shoulder
range of motion.
 Followup radiographs will dictate the timing for fixator removal (average approximately
7 weeks).
LOWER EXTREMITIEs
Roger Anderson External Fixator
screw are placed into the bone above and below
the fracture, and a devise is attached to the screws from
outside the skin, where it may be adjusted to realign the
bone.

Indication
 comminuted fracture of the long bone
Nursing Interventions