Place the patient on the CAST stand with the ankle in a neutral position. Place the stockinette on the patient's leg, from the thigh to one to two inches past the toes. Make sure you have plenty of extra stockinette at the top of the leg. Put out the stockinette on the front of the ankle. Start wrapping the cotton padding. Wrap the bottom of the cast the same way you would a short leg cast. Begin wrapping at the instep of the foot and wrap to the end of the toes. Then work your way back up the foot and ankle and up the leg. Wrap up to just above the knee. Make sure the knee is well padded. Place a two-layered folded strip of padding over the tibia. Then wrap padding over that strip. We're going to roll that in. Apply a two-layered strip of padding, like a stirrup, under the foot, and wrap padding over that strip. We're going to have a double layer and a triple layer for the stirrup in the back of the heel. So the stirrup is a double layer. And then the triple layer goes along the back of the heel. Place a three-layered strip of padding on the back of the heel and under the foot. Wrap padding over that strip as well. I want to make sure we have good padding up here at the knee. Apply another 50-50 cotton padding wrap to the knee. Make sure that the knee is well padded. We're going to wrap the fiberglass just like we did the short leg. Apply the fiberglass, beginning the same way you would a short leg cast. Begin wrapping at the forefoot and wrap to the end of the toes. Then wrap up the leg. Come out so we get a good support under the metatarsal heads. Trim the cotton padding and fiberglass at the toes. Make sure that little toe has good clearance. Separate the padding and the fiberglass and cut only the fiberglass on the bottom and cut it rounded to support the metatarsal heads. Underneath the toes, separate the fiberglass and padding and only cut the fiberglass at the bottom, making sure the metatarsal heads have cushion. Take the second layer of fiberglass. Apply a second layer of fiberglass. Mold at the arch as the fiberglass hardens. Now, I'll take my 3-inch must blend. Apply a third layer of fiberglass. Begin wrapping just below the knee and wrap down the leg. Place the splint on the back of the heel and under the foot, and wrap the splint on using the fiberglass. Make two slits on either side of the splint at the heel in order to tuck the sides of the splint in and wrap the fiberglass over it smoothly. Trim the splint under the foot so that it's the same length as the cast. Then fold the stockinette back and mold the cast while the fiberglass hardens. Take the foot off the cast stand and let the patient's leg relax, hanging at a slight angle so the knee is still bent. And then we're going to take two more three-inch rolls. Take two more three-inch rolls of fiberglass. Start wrapping below the knee where you left off, and wrap up the knee. And then I make a fan fold. I come way down. Make a fan fold over the knee. Wrap the fan fold in, and then continue wrapping down the leg. And wrap that in. You just want to come way down so you get a good mesh between the two pieces. If you only bring your fiberglass to about right here, these two won't separate. As the fiberglass dries, mold in the patellar tendon. And as this starts to dry, you want to push in on the patellar tendon. Just keep pressure right there. This cast is made to help distribute the weight between the patellar tendon and also to control rotation while weight bearing. Using a marker, draw where you are going to cut out the cast. Draw a line around the kneecap, rounding the fiberglass up around the kneecap. It should be shaped like a U, with the kneecap in the center, resembling Mickey Mouse ears. At the back of the leg, draw a line at the normal height of a short leg cast. Then use the cast saw to cut along the lines you drew. When you get it cut, you want to kind of pull the knee up to see if it's binding anywhere, so it needs to come down a little bit more on her kneecap. Use scissors to cut out the padding. Cut straight down in the back, fold the padding over, and cut the kneecap out. Take three strips of padding and place them on both sides of the leg to ensure there's enough padding around the knee. Then fold the stockinette down. And then you apply your color roll. Finish with a colored roll. When you come around here, get that locked in good. And as you can see, when she straightens her knee out, see how it grabs her kneecap and won't let her rotate. And that is a PTV.

PTV cast

patellar tendon-bearing cast

weight distribution

leg immobilization

fiberglass application