we're gonna start at the beginning by cutting the stockinette you can see that hold for the thumb and it's a quarter inch to a third of an inch you can gather the stockinette and slip it over the arm with the thumb in the hole I like my stocking neck to go to my elbow or slightly above and also to my fingernails that way I can fold it back have plenty room here's my Gumby we're gonna cut on the black line I slipped the Gumby over the hand goes into the black line the thumb goes into the rest of the stockinette and you can see how I have a band going around the wrist and it goes up the thumb and that'll protect the thumb from the edges of the fiberglass end from the patient pulling out the padding we're starting to padding around the wrist we do an anchor around the wrist we bring it forward we go to the palm area straight down around the thumb through the palm area again and we can do that two or three times depending how much padding you want now I'm going to rip it off because I find that new casters have problem with the transition between the hand the wrist and a forum someone to just do it in two parts as I rolled up the forearm I'm not too particular how smooth it is this is because of a new technique we've developed now as I'm rolling it back down the arm watch what I do as I'm rolling it back down the arm I'm compressing the padding roll the round compressing the padding I have my fingers on top of the padding roll not underneath the roll and I'm compressing it to the forum keep rolling I'm covering up about 1/2 as I go down which gives me two extra layers for a total about four layers now I'm rolling back you notice how smooth it is here I'm rolling back my stocking net and we do this before we start casting which may be different than you're doing it but you'll see why in a minute roll back to stockinette be careful not to crinkle it and now I'm rolling the thumb stockinette down to the first di P joint the distal di P joint and then I'm rolling it back again and you can see I want to spread it out as far as possible most important part is spread that out I'll mark it for you so you can see it and that'll protect the edge of the thumb and also cover all the padding once the fiberglass is on so the patient can't pick it out now I'm cutting my fingers these fingers will hold the stocking net between the layers of fiberglass it'll prevent the patient from pushing me stocking net and padding down under the fiberglass why do we do that because we don't want the entire circumference of stockinette in between the layers of the fiberglass that'll weaken a fiber glass now I can also cut my finger at my palm area but for the demonstration I will not I'll start rolling the fiberglass around the wrist I'll do an anchor around the wrist incorporating part of the Gumby go around once and swing it forward go up the back of the hand and now I'll do my wave my pinch my wave my pinch wave pinch turn to 90 degrees towards me turn it back and lay it down don't forget to keep it a little bit taut as you go in the web space area now you notice I pulled it around the thumb and come forward towards the palm again because that's where I want my strength the palm wrist area I keep on putting a little bit more around the palm rest area by coming forward and now I'm going to go up the arm as I get to the area where I cut the finger i'll coorporate the finger in between the layers of fiberglass I'll continue going around and cinching this a little bit why because we have adipose tissue in that area of the forearm and we can cinch it a little bit I'll finish off the roll I'm laminating laminating laminating I'm doing my molds now here you can see I'm smoothing out the ridges in the Palmer area here is the interosseous mold between the radius in the ulna and I'm pressing with my right hand in the Palmer area and Wolle area and here is the triangle mold at the end of the cast the most proximal part of the cast again I go back to the interosseous mold the Palmer mold getting all the ridges down meanwhile I'm always laminating and molding laminating a molding and that's it and you can see how the fiberglass covers with the addition of the stocking neck covers all the padding so the patient cannot pull out any padding as you can touch all their fingers plenty of room here it is from the reverse angle I have my stocking at all set I do an anchor for the padding around the wrist come forward set myself up to go through the web space again go twice through around the thumb and I can tear it off there and start again at the wrist area and go up the forearm and I'm covering up about a third to a half as they go up I'm just rolling it around now as I come back down I'm compressing it smooths out the padding gives a better foundation to roll the fiberglass and I should have about three to four layers I'm rolling down my panting before I do that gonna do something special here we're gonna do a bumper I'll just take a pair of a piece of 3-inch divided in half they're folded in half excuse me fold it in half and now pull down the stocking net that gives a little bumper a little more comfort now so I don't get any creases my stockinette I'm the cut this tucking it a little bit before I fold back I make the first fold on the Gumby to the distal pipey joint and then I do the second fold and I spread it out as much as possible we want that entire area covered by the fiberglass so no padding sneaks through I'll cut my fingers and I'll do it up to the bumper I'll fold it back and I can do those 180 degrees from each other on both ends of the cast for our demonstration purposes only do one I start with the anchor and I incorporate part of the Gumby and back in a thumb go around once I swing it forward to set myself up going through the web space now watch this wave pinch wave pinch turn it 90 degrees keep it a little taught go around the web space and down the palm straight up now watch me pull it around the thumb area and I'm going towards the palm again so I get more fiberglass in the wrist palm area again wave pinch turn it 90 degrees lay it down a little bit taught in the web space come up go around the wrist and they can start going up the forearm [Music] when I get towards the top I'm gonna cinch it a little bit because we have the a Depot's of fat tissue there incorporate the finger go around and cooperating the finger [Music] and finish off the cast you notice I'm only using one 3-inch roll this would be fine for 90% of your patients if you have that 225 pound highschool linebacker you may want to put an extra roll on there you know your patients I do my molding and terasi small triangular mold pressing down the ridges do my lamination go back to molding that's it