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Short Arm Cast

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Other Names

Distribution of the short arm cast[1]
Application of the cast padding over the stockinette[2]
Final product using fiberglass[3]
Final product using plaster[1]
  • Short Arm Cast

Background

  • This page describes the short arm cast
    • Extends from proximal forearm to mid-distal hand

Indications


Contraindications

  • Proximal or mid-forearm fractures
    • These require immobilization of the elbow
  • Most acute fractures
  • Open fractures
  • Injuries with neurovascular compromise
  • Fractures with active swelling

Procedure

Equipment

Technique

  • Patient position
    • Hold the elbow at 90° during casting (note: elbow is not immobilized)
    • Wrist is immobilized in about 20° extension (neutral position)
  • Stockinette/ tubular bandage
    • Start on proximal one third of forearm
    • To distal palmer crease volarly, just proximal to MCP joints dorsally
    • Cut a hole for the thumb
    • Cut about 5 cm of extra length on each end of the stockinette
  • Cast padding
    • Wrap circumferentially from distal to proximal
    • Typically a 2-4 layers of padding is sufficient
    • There should be no creases in the stockinette or cast padding
  • Cast material
    • Wrap from distal to proximal
    • For plaster, 4-6 layers is adequate; for fiberglass, 2-4 layers is adequate
    • 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
  • Confirm neurovascular exam

Pearls and Pitfalls

  • Care should be taken to ensure cast does not restrict flexion of MCP joints
  • Consider a shoulder sling for comfort

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. 1.0 1.1 Image courtesy of https://www.cfp.ca/content/64/10/746
  2. Image courtesy of uptodate.com
  3. Image courtesy of ueortho.com
Created by:
Jesse Fodero on 10 July 2019 17:11:45
Authors:
Last edited:
31 July 2023 15:06:19
Category: