injuries poisoning
How To Apply a Short Leg Cast
Step by Step Description of Procedure
Apply stockinette to cover the area (eg, about 5 to 10 cm) proximal and distal to the anticipated extent of casting material. When finished, the cast should cover the area from just proximal to the metatarsal heads to just distal to the fibular head. Place several layers of padding (typically 4). Wrap the padding circumferentially, from distal to proximal, over the area to which the cast will be applied. Overlap the underlying layer by half the width of the padding. Apply the padding firmly against the skin without gaps but not so tightly that is compromises circulation. Smooth the padding as necessary to avoid protrusions and lumps. Tear away some of the padding in areas of wrinkling to smooth the padding. Consider adding padding over bony prominences. Immerse the casting material in lukewarm water. Gently squeeze (do not wring out) excess water from the casting material. (Do not wring out plaster.) Apply the casting material circumferentially from the metatarsal joints to just distal to the fibular head, overlapping the underlying layer by half the width of the casting material. Smooth out casting material to fill in the interstices in the plaster, bond the layers together, and conform to the contour of the leg. Use your palms rather than your fingertips to prevent the development of indentations that will predispose the patient to pressure ulcers. Place 4 to 6 layers of plaster (typically) to ensure adequate immobilization. Each layer overlaps by half the width; this requires 2 to 3 passes circumferentially. For fiberglass, 2 to 4 layers are usually adequate. (Follow product-specific instructions for application.) Fold back the stockinette before adding the last layer of casting material. Roll back the extra stockinette and cotton padding at the outer margins of the cast to cover the raw edges of the splinting material and create a smooth edge; secure the stockinette under the casting material. Check for distal neurovascular status (eg, capillary refill, distal sensation) and motor function. Maintain the ankle in neutral position at 90° until the casting material hardens sufficiently, typically 10 to 15 minutes. 