Place the arm in neutral position. Place the stockinette on the arm from one inch past the fingertips to the elbow. You can either cut the thumb hole prior to placing the stockinette, or you can cut the thumb hole after applying the stockinette. Place one-inch stockinette on the thumb. Apply cast padding, starting to wrap around the wrist and then go through the web space. Go up and around the thumb before going back down around the wrist and down the arm using 50-50 coverage. Do three turns at the hand for the bumper. Then go back around the base of the thumb before going up the arm toward the elbow. Wrap around two fingers past the elbow, unless otherwise instructed by the physician. Make three turns at the top of the arm for the bumper and then move back down the arm to ensure coverage. Apply fiberglass, starting at the wrist, and then moving through the waist. You can do a fan fold at the base of the thumb to make the cast stronger before moving up through the thumb and hand. On these I usually do the cut instead of the twist just because it lays nicer right there like that. Next, move back down the wrist and arm. Keep the hand and thumb in a C-shaped position as if you were holding a can. Fold the stockinette at the hand and at the tip of the thumb. Then I do the cut here, and the cut here, and fold those. Fold the thumb stockinette back. And if the IP is supposed to be free, you just cut that back further. And then I cut a big hole for this one. Mold the cast. Use an interosseous mold, keeping the hand and thumb in C-shaped position. Mold in the palm and maintain neutral position at the wrist. Remember to always mold with your palms, never your fingers. Continue applying the fiberglass, beginning where you left off. Wrap up the arm and around the elbow, doing a fan fold at the elbow. Cut the fiberglass out at the front of the elbow to allow flexion. Make sure there are no points or sharp edges at the top of your fiberglass. Mold the cast while the fiberglass hardens. Cut the padding on the inside of the elbow out. Fold over the stockinette at the top of the arm. Finish the cast by applying the colored roll, wrapping from the elbow, over the thumb, and up the hand. Then go back down the elbow. Finish molding the cast. Use an interosseous mold, keeping the hand and thumb in C-shaped position. Mold in the palm and maintain neutral position at the wrist. Remember to always mold with your palms, never your fingers. And that's a solid sugar tongue thumb Spica. To remove the cast, cut along the top and bottom of the cast, following the lines drawn in the video.

sugar tongue thumb Spica cast

arm positioning

stockinette application

fiberglass casting

cast removal