How to Apply a Stockinette and Fiberglass Cast

Preparation and Initial Application

Cutting the Stockinette:
- Cut a hole for the thumb about 1/4 to 1/3 inch in size.
- Slip the stockinette over the arm with the thumb in the hole.
- Ensure the stockinette extends to the elbow or slightly above and also to the fingernails.
- Fold back the stockinette to have plenty of room.
Using Gumby:
- Cut on the black line, slip Gumby over the hand.
- Hand goes into the black line, thumb into the rest of the stockinette.
- Gumby helps protect the thumb from the edges of the fiberglass and patient manipulation.

Initial Padding:
- Anchor padding around the wrist.
- Bring it forward to the palm area, around the thumb, and back through the palm area 2-3 times.
- If the transition between hand and wrist is difficult, apply padding in two parts.
Rolling the Padding:
- Roll up the forearm (exact smoothness is less critical due to new technique).
- Roll back down the arm, compressing the padding for a smoother fit.
- Cover about half as you go down for extra layers (total ~4 layers).
Stockinette Adjustment:
- Roll back the stockinette before casting.
- Roll the thumb stockinette to the first DIP joint and back again, ensuring a wide spread.
- Cut the fingers area to hold the stockinette between fiberglass layers.
- This prevents pushing down the stockinette and padding under the fiberglass.

Starting the Fiberglass Application:
- Start around the wrist, incorporating part of the Gumby.
- Go around once and swing forward, going up the hand.
- Perform wave and pinch maneuvers for a snug fit.
- Ensure the area around the thumb and palm has extra strength.
Continuing Up the Arm:
- Incorporate cuts in the stockinette as you go up the arm.
- Cinch it slightly around areas with more adipose tissue.
- Continue laminating and molding for a snug fit.

Final Stockinette Rollback:
- Roll down the thumb stockinette and cut fingers again.
- Fold back stockinette to cover all padding areas.
Creating a Bumper:
- Divide and fold a piece of 3-inch padding in half and pull down stockinette over it for comfort.
- Cut the stockinette slightly to prevent creases.
- Fold on the Gumby to the distal PIP joint, spread out for even coverage.
Completing the Cast:
- Start with an anchor around the wrist, incorporating Gumby and thumb.
- Use wave and pinch maneuvers for web space and palm.
- Continue up the forearm, cinching slightly around adipose areas.
- Only one 3-inch roll is typically needed, additional layers for heavier patients.
- Finish with interosseous, Palmer, and triangular molds to smooth and laminate.