Make sure the wrist is extended 10 to 20 degrees and the middle and index fingers at an intrinsic plus to a 90 degree angle. It should end up looking like a cobra. Cut up the side of the stockinette. Slide the stockinette over the forearm so it goes from the antecubital crease of the elbow all the way past the fingers. Cut three quarters of the way down both sides of a one inch stockinette. By doing that, you can slide over the two fingers. So you'll notice there's not stocking yet between the thumb because all of that is going to be casted in. Begin wrapping with 2-inch cotton padding at the wrist using 50-50 coverage. Wrap three times at the wrist, then move up through the web space at least two times. Then wrap three times around the two fingers so there is plenty of padding. Make sure the fingers do not overlap. You can get good padding on the back of the metacarpals. You want to keep the patient's wrist back as you're wrapping. And then work your way down two inches from the antecubital crease in the elbow. Wrap three times at the bottom of the cast for a bumper. Then wrap up the arm one more time to ensure adequate padding. You may use a fiberglass splint, or roll-out fiberglass to add additional strength. Fold your splint in half, and measure the length of the fingers. Cut the end of the splint to create a dip so that it molds around the fingers. Trim one end of the splint to the appropriate length, and on the other end, cut up the fold in the middle to the bottom of the fingers. And then when you measure the length of the fingers, you want to cut up the center of your splint to about the length of the fingers. Wet the splint, and wring out as much water as possible. Place the splint in the web space of the index finger and thumb, and around the middle and index fingers. Wrap with a one- or two-inch fiberglass to hold in place. Then you want to bring your splint sort of to the center of the palm so that it's not rubbing where it would rub the thumb and pretty much straight down the back. As you wrap, bring the splint to the center of the palmer side of the hand and straight down the back on the other side. Make sure as you are wrapping that the patient is keeping their wrist back. Wrap with a second 2-inch fiberglass roll to anchor the splint in place. Mold the cast. Make sure the wrist is extended 30 degrees and the fingers are at 90 degrees. Use an interosseous mold for the arm. Then mold the hand, making sure to mold using your palm, not your fingertips. Trim any edges as needed. Fold the stockinette back at the fingers. Take your stockinette and fold back over the fingers. Then you just fold this stockinette back. Continue to mold the cast. Cut two slits opposite of each other at the proximal end and fold back the stockinette. Finish by wrapping with a color roll. Ensure that the cast has a good mold. And you usually have to cut a little slit right here to get that to lay down when you come across. And then you just want to get it good and molded. Make sure you're keeping the wrist back and the fingers down. And you have to hold it right here to make sure it lays down. And that's the radial gutter cast. To remove the cast, cut along the top and bottom of the cast, following the lines drawn in the video.

applying radial gutter cast

removing radial gutter cast

wrist extension cast

fiberglass splint application

cast removal instructions