Upper Extremity Cast Application.

This chapter aims to provide a comprehensive review of the techniques and challenges associated with applying upper extremity casts in pediatric patients. The chapter, along with its accompanying figures and video clips, serves as an introductory guide to pediatric orthopaedic cast application for trainees. Generally, casts are used to preserve appropriate alignment rather than to create improved alignment. In cases of nondisplaced fractures or those with acceptable alignment, the role of the cast is to maintain that alignment until healing occurs. For fractures with unacceptable alignment, reducing them to an acceptable position is necessary while the cast is utilized to maintain proper alignment. For challenging fractures that are difficult to keep aligned, have displaced intraarticular components, or are length-unstable, surgical intervention is recommended, followed by casting for immobilization after surgery. This chapter reviews the indications, application, techniques, and pitfalls of short arm, thumb spica, mitten, ulnar gutter, long arm, and hanging arm casts.

Key concepts: (1)The cast index is a valuable measure that impacts the rates of loss of reduction in distal radius fractures.(2)Molds are important not only for maintaining fracture reduction but also for keeping the cast in position and preventing slippage.(3)Along with using a cast saw to split fiberglass casts, a cast splitter should be employed to ensure proper bivalving.