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Long Arm Cast

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Other Names

Demonstration of the long arm cast[1]
Illustration of the stockinette in the long arm cast[2]
  • Long Arm Cast

Background

  • This page describes the long arm cast
    • Often used in pediatric upper extremity casting
  • Benefits over the short arm cast
    • Prevents pronation/ supination
    • Immobilizes the elbow
    • Prevents the cast from slipping down

Indications


Contraindications

  • Absolute contraindications
    • None
  • Relative contraindications
    • Most acute fractures
    • Open fractures
    • Injuries with neurovascular compromise

Procedure

Equipment

Technique

  • Patient position
    • Keep the arm slightly extended past 90°
  • Stockinette/ tubular bandage
    • Place proximal segment in axilla, extend over distal fingertips
    • Cut a hole for the thumb
  • Cast padding
    • Wrap circumferentially from distal to proximal
    • Typically a single layer of padding is sufficient
    • Provide additional padding to bony prominences at the elbow including the condyles and olecranon
  • There should be no creases in the stockinette or cast padding
  • Cast material
    • Wrap from distal to proximal
    • Trim excess material to accommodate thumb and fingers
    • Fold the proximal and distal ends of the stockinette over the cast
    • Apply an additional layer of cast material
  • Apply a 3 point fixation at the fracture site until the material hardens
  • Arm should be supported in a shoulder sling
  • Confirm neurovascular exam

Pearls and Pitfalls

  • Avoid overstuffing the antecubital fossa
  • Avoid creases in the antecubital fossa
    • Can apply padding/ taping at slightly flexed at 90°, then extend to slightly past 90°
  • Care should be taken to ensure cast does not restrict flexion of MCP joints

Aftercare

  • Typically non-weight bearing until re-evaluated
  • Advise patient to keep cast or splint clean and dry
  • Do not insert objects into splint/ cast
  • Monitor for complications (worsening pain, paresthesia/ numbness, color changes)
  • Seek further care if unable to control pain at home

Complications

  • Acute Compartment syndrome
    • The ability to passively/actively extend fingers without discomfort indicates absence of muscle compartment compression
  • Plaster burn/ thermal injury
  • Pressure sores
  • Nerve palsy
  • Vascular compromise
  • Splint dermatitis
  • Permanent joint stiffness
  • Skin infection

See Also


References

  1. Image courtesy of orthoinfo.aaos.org, "Care of Casts and Splints"
  2. Image courtesy of https://surgeryreference.aofoundation.org/, "Long arm cast"
Created by:
Jesse Fodero on 10 July 2019 16:22:15
Authors:
Last edited:
31 July 2023 15:06:12
Category: