Application Technique Thumb Cast

Indications:

  • Thumb fractures.
  • Dislocations of the thumb.
  • Capsule and ligament injuries.
  • Tendon injuries.
  • Ritz-arthrosis.
  • Tendopathy.
  • Soft tissue injuries.
  • Positioning splint.
  • Physio purposes.
Application: The materials should be pre-prepared to enable rapid application of the bandage. All the necessary materials should be placed within reach to avoid hold-ups in the procedure.

The patient should be in a position which is comfortable to him/her and the person applying the bandage. This may vary depending on the extent of the injury, the diagnosis, the treatment method and the patient's condition.

Materials required: 1 x 5 cm Delta Cast Conformable polyester support bandage with hydrogel-coated casting gloves, toweling tubular bandage, fleece padding, tape or adhesive bandage, bandage scissors, felt-tip pen.

Photo 1:
The toweling tubular bandage is pulled over the finger, hand and wrist to form a layer of padding underneath. A narrow strip of fleece padding is inserted beforehand to help with the cutting. The cast is wrapped around using circular movements, starting at the thumb (2 layers), round the basal thumb joint (3-4 layers) continuing over the hand and wrist (2-3 layers).

Photo 2:
The cast is molded for approximately 4 - 6 minutes to the thumb and hand area to optimize the fit and the bonding of the layers.

Photo 3:
Following the molding phase the cutting lines are marked and the cast opened at the side using bandage scissors.

Photo 4:
The cast is removed and trimmed for individual fit. On the outer side of the thumb area the cast is opened as far as the basal joint and a strip of cast approximately 1 to 2 cm wide removed. If immobilization of the wrist is required, the cast should not be shortened at the proximal end. The fit of the cast on the patient is then checked.

Photo 5:
Various types of bandage can be used to fix the cast in place.
a) The use of tape simplifies the application and removal of the cast. Two strips of tape are attached to the cast in the thumb area and one strip of tape in the hand area taking into account the state of the swelling.
b) Depending on the state of the swelling, the cast can be attached above the wrist using an adhesive bandage. These different possibilities improve the closeness of the fit and make the cast more secure.

The small number of layers means that the cast remains semi-flexible and can be adjusted depending on the individual state of the swelling (looser or tighter). To do this, the tape strapping or adhesive bandage is removed and the cast altered for a perfect fit. Re-application is carried out as described above.

1.
2.
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5.a)
5.b)
Variant:

Short thumb cast: Through cutting at the distal thumb end the thumb can get its full function back. This leads to a focused fixation of the base thumb joint.

Thumb cast with wrist inclusion: Here the proximal part of the cast stays on. This has the effect of stabilizing the base thumb joint and the wrist.

Scaphoid cast: After application of a Terry Cloth Stockinet the cast gets applied proximal up to the elbow in the sense of focused rigidity casting. (See also: Radius cast). In most cases it is not necessary to split the cast in the thumb region. The scaphoid cast is a combination of the thumb- and radius casts.

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