Lecture Notes: Application of a Long Leg Cast

Initial Positioning and Preparation

• Positioning the Patient:
  • Prefer a sitting position to use gravity for fracture alignment.
  • Recumbent positions can cause discomfort and more movement.
• Stockinette Application:
  • Use one or two stockinettes, with a larger size on the thigh.
  • Ensure smooth application and check alignment continuously.

Patient Interaction

• Communicate with the patient to keep them at ease.
• Be cautious about patient discomfort and pain during application.

Applying the Cast

• Foot and Leg Placement:
  • Foot placement is crucial, especially for unstable tibia/fibula fractures.
  • Keep foot in plantar flexion as patient comfort allows.
• Padding:
  • Essential padding on the heel to prevent blistering.
  • Ensure no wrinkles in the popliteal area.

Application Technique

• Tools and Materials:
  • Choose cast roll size (3-inch or 4-inch) based on patient size.
• Layering:
  • Start with a short leg cast for easier transition.
  • Ensure good coverage and adequate strength with 3-4 layers.

Alignment and Checking

• Continuous Checks:
  • Ensure proper alignment of hip, knee, and foot.
  • Regularly check for x-ray results to guide treatment.

Cast Stabilization and Proximal Application

• Proximal Portion:
  • Move patient to table for better access and comfort.
  • Flex knee around 30-40 degrees for mobility.
• Padding on Thigh:
  • Ensure sufficient padding to avoid irritation.

Final Checks and Molding

• Alignment and Molding:
  • Maintain alignment with first web space, patella, and femoral head.
  • Apply supra-condylar mold to prevent proximal pivoting.
• Finishing the Cast:
  • Use lotion or aggressive rubbing for a smooth finish.
  • Evaluate strength, especially at the heel.

Post-Application Considerations

• Patient Comfort:
  • Explain the process to the patient before starting.
  • Manage patient expectations and discomfort.
• Cutting and Removal:
  • Use caution when cutting, especially around bony prominences.
  • Maintain blade safety and listen to patient feedback on discomfort.
• Learning from Practice:
  • Evaluate the cast for imperfections after application.
  • Use feedback for continuous improvement.