Short Arm Cast

Other Names

Distribution of the short arm cast

Application of the cast padding over the stockinette

Final product using fiberglass

Final product using plaster

• Short Arm Cast

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Background

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

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Indications

• Distal Radius Fracture
  • Non-displaced or minimally displaced
• Pediatric fractures
  • Buckle Fracture
  • Greenstick Fracture
  • Some Salter Harris Fractures
• Carpal Fractures
  • Excluding scaphoid, trapezium
• Certain carpal dislocations
  • Lunate Dislocation
  • Perilunate Dislocation
• Some metacarpal fractures
  • Second to fifth

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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

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Procedure

Equipment

• See: Casting materials

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

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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

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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
  • Cellulitis from underlying wound, pressure ulcers

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See Also

• Casting Main
• Procedures Main

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