Orthopaedic Technologist Certified Upper Extremity Casting Questions and Answers — Questions and Answers
Question 1: A patient with a mid-shaft ulnar and radial fracture (both-bone forearm fracture) requires immobilization. Which casting technique is MOST appropriate to effectively control forearm rotation?
- Short arm cast
- Ulnar gutter splint
- Long arm cast (Correct answer)
- Sugar-tong splint
Correct answer: Long arm cast
A long arm cast, which immobilizes the elbow in 90 degrees of flexion, is necessary to control pronation and supination of the forearm, thereby preventing displacement of both-bone forearm fractures. Short arm casts do not adequately control forearm rotation.
Question 2: When applying a short arm cast for a distal radius fracture, what is the correct distal landmark for the plaster or fiberglass?
- The distal interphalangeal (DIP) joints
- The proximal palmar crease (Correct answer)
- The wrist crease
- The mid-palm
Correct answer: The proximal palmar crease
The distal edge of a short arm cast should extend to the proximal palmar crease (or metacarpal heads) to allow for full flexion of the metacarpophalangeal (MCP) joints. Extending it further would unnecessarily immobilize the fingers.
Question 3: A patient reports intense, burning pain and swelling in their hand 6 hours after a short arm cast was applied for a wrist fracture. Their fingers appear pale and cool to the touch. Which of the following is the MOST critical immediate action?
- Administer pain medication and instruct the patient to elevate the arm.
- Immediately bivalve or remove the cast and notify the physician. (Correct answer)
- Reassure the patient that some swelling and pain is normal.
- Schedule a follow-up appointment for the next day to check the cast fit.
Correct answer: Immediately bivalve or remove the cast and notify the physician.
The patient's symptoms are classic signs of compartment syndrome, a serious condition caused by increased pressure within a muscle compartment that can lead to muscle and nerve damage. The only appropriate immediate action is to relieve the pressure by splitting or removing the cast and urgently consulting the physician.
Question 4: When molding a short arm cast, which part of the hand should be used to apply pressure and conform the material to the limb's anatomy?
- Fingertips
- Knuckles
- Back of the hand
- Thenar eminence/palms (Correct answer)
Correct answer: Thenar eminence/palms
The palms and thenar eminence should be used to mold a cast. Using fingertips can create indentations in the cast, which can lead to pressure sores and skin breakdown for the patient underneath.
Question 5: Which of the following is a primary advantage of using a sugar-tong splint over a circumferential cast for an acute, unstable distal forearm fracture?
- It provides superior immobilization of the elbow.
- It is less expensive than a traditional cast.
- It accommodates for initial swelling better than a circumferential cast. (Correct answer)
- It allows for earlier range of motion at the wrist.
Correct answer: It accommodates for initial swelling better than a circumferential cast.
A key advantage of splints, like the sugar-tong, is that they are not circumferential. This allows them to better accommodate the significant soft tissue swelling that often occurs with acute fractures, reducing the risk of compartment syndrome.
Question 6: To ensure adequate protection and prevent skin irritation, how should cast padding be applied?
- Tightly stretched to reduce bulk
- With a 25% overlap between layers
- With a 50% overlap and extra layers over bony prominences (Correct answer)
- Applied only over the fracture site
Correct answer: With a 50% overlap and extra layers over bony prominences
Cast padding should be applied with approximately 50% overlap to create at least two layers between the skin and the cast material. Bony prominences require extra padding to prevent pressure sores. Applying padding too tightly can be constrictive, while too little overlap can leave skin unprotected.
Orthopaedic Technologist Certified Upper Extremity Casting Questions and Answers
A patient with a mid-shaft ulnar and radial fracture (both-bone forearm fracture) requires immobilization.
Which casting technique is MOST appropriate to effectively control forearm rotation?