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AAOE Casting, Splinting and Soft Goods Program
Casting - Sugar Tong Cast (Muenster Cast)
Casting - Sugar Tong Cast (Muenster Cast)
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Video Transcription
Maintain a neutral position of the wrist, with the elbow at 90 degrees. Cut a hole for the thumb on one side of the stockinette, and place on the arm from tip of the fingers to 3 inches above the elbow. Note that another option is to cut the thumb hole after placing the stockinette on the arm. You want to fold the stockinette at the elbow, not cut it out like we normally would. Make sure you're not rotating the arm. Start wrapping padding at the wrist, and wrap distally toward the hand. Make 3 turns around the hand for the bumper. Wrap the rest of the padding proximally up the arm, covering 50-50 with each turn. You just want to roll right above the elbow with your padding. Make 3 turns around the top of the cast, right above the elbow, for the bumper. Make sure you get the elbow. Place additional padding over the elbow and ulnar styloid to pad the bony prominence. Roll the padding back down, making sure you have good coverage everywhere. Start the fiberglass. Start fiberglass at the wrist, and do a fan fold with the base of the thumb in the center of the roll. Wrap the fan fold in on the back of the thumb first, then wrap around the hand with a twist or cut between the thumb and the index finger. You can cut and fold or twist at the hand, whatever you're more comfortable with. Make 2 turns around the hand, and wrap up toward the forearm. Stop the first roll just below the elbow. We do the short arm portion first, so that we don't have to worry about keeping the elbow at 90 degrees, while we're wrapping this portion. Make 2 turns around the hand, and wrap up toward the forearm. Stop the first roll just below the elbow. While we're wrapping this portion... Make cuts on each side of the cast of the hand, and fold the padding and stockinette back. Cut a hole for the thumb. And then just mold it into the palm. Mold the cast to conform to the hand, and press into the palm. Occasionally you'll have a doctor reduce one of these casts, and most of the time they'll reduce it with just the short arm portion on. I usually use a 3 inch roll at the top. Make sure you get the elbow at 90. Keeping the elbow at 90 degrees, begin wrapping your second roll of fiberglass by overlapping the end of your first roll of fiberglass, and continue wrapping to about 2 inches above the elbow. Use 2 fan folds over the elbow. Wrap that in, and then come back and do another fan fold right over the elbow. And then you just wrap that in. Wrap down to make sure your casts get a good meshing together. With doing the fan fold in the back of the elbow, you don't have to come up higher and cut down. You can just leave that edge there in the back. Cut away the fiberglass and padding in the antecubital crease to allow the patient to bend their arm. Pull that part out. Cut your padding back so they can bend their arm good. And then all you have to do is fold your padding back over the top of your cast. Cut a slit from the top of the stockinette to the anti-cubital crease and fold the stockinette over. Gently bring it down over so you don't wrinkle your fiberglass. Your stockinette should stick to your casting material, but some people tape it and that's okay too. And then take your color roll. Finish the cast with color wrap. Thank you. So, this cast controls rotation of the forearm, but still allows flexion of the elbow. It won't allow extension. That is a solid sugar tone cast. To remove the cast, cut along the top and bottom of the cast, following the lines drawn in this video.
Video Summary
This video provides instructions on how to apply a sugar-tong cast. The process involves maintaining a neutral wrist position and cutting a thumb hole in the stockinette. Padding is wrapped around the arm, covering the wrist, hand, and elbow. Fiberglass is then applied, starting at the wrist and wrapping towards the forearm. The cast is molded to conform to the hand and elbow. A second roll of fiberglass is applied, overlapping the first and covering the elbow with fan folds. The cast is finished with a color wrap. To remove the cast, it is recommended to cut along the top and bottom following the instructions in the video.
Keywords
sugar-tong cast
applying cast instructions
neutral wrist position
thumb hole in stockinette
fiberglass application
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