Material
- Stockinette; select the appropriate size.
- Synthetic wadding.
- Plaster rolls; select the appropriate width, depending on the size of the arm; remove the plaster rolls from the packaging.
- Bandage scissors.
- Sling or collar’n’cuff.
Procedure
- Fill a small bucket with lukewarm water (around 20° C) and place this as close to the treatment table as possible.
- Ask the patient to sit at the treatment table with the arm in the position in which it is to be immobilised.
- The elbow should be at a 90° angle, the wrist should be in slight dorsal flexion and the forearm in neutral rotation.
- Determine the required length of stockinette (about 1.5 x the length of the actual plaster bandage).
- Slide the stockinette over the arm; cut a hole for the thumb beforehand.
- Place a layer of padding all around, putting an additional layer on pressure-sensitive points.
- Cut a hole for the thumb [Figure 124].
Figure 124
- Cut out a triangle in the plaster bandage for the thumb.
- Submerge the roll of plaster under water until no more air bubbles are released.
- If the plaster bandage is held under water at an angle, a few seconds will be sufficient [Figure 125].
Figure 125
- Remove the plaster roll from the water and gently squeeze out any excess water.
- Apply the plaster bandage in a circular fashion, working in a distal to proximal direction.
- Distribute the pressure to avoid causing vascular congestion.
- The dorsal side of the metacarpal joints should remain uncovered, while on the volar side the plaster should not reach beyond the distal horizontal palmar crease [Figure 126].
Figure 126
- Fold the stockinette over at both ends.
- Mould the plaster, with the elbow in 90° flexion and in a neutral position between pronation and supination.
- The wrist should be held in about 15° dorsal flexion.
- Avoid making indentations with your fingers.
- Apply the next roll of plaster, entirely covering the folded over stockinette [Figure 127].
Figure 127
- Avoid making indentations with your fingers (be mindful of the risk of pressure necrosis).
- Ensure throughout that the joint is maintained in the correct position until the plaster has hardened [Figure 128].
Figure 128
- Inform the patient that heat will be given off during the hardening process.
- Once the plaster cast has hardened, apply a sling or collar’n’cuff.
- Tell the patient that it will be at least another 24 hours before the plaster is hard enough to take a knock.
- Ask the patient to inform you immediately if the fingers on the immobilised arm turn blue or pale.
- Instruct the patient to regularly move their fingers [Figure 129].
Figure 129
How to Apply a Circumferential Plaster Cast to the Forearm and Hand
This should be carried out in exactly the same way as for a “circumferential cast for the entire arm and hand.” The only difference is that the elbow should remain uncovered, with the circumferential cast reaching proximally to the top of the radius.