How to Apply an Ulnar Gutter Cast

Host: For this casting procedure you need wrap roll, three inch plaster slabs, roll of gauze and a bucket of warm water. The position of the patient's hands will be crucial. You might find it best to have the patient supine. The elbow is bent at 90 degrees and an auto detective tension of the MCP area the wrist will be extended by above 20 degrees with the fourth and fifth fingers flexed to create a Z shape.

Before we begin the casting, we will take a small section of the wrap roll or gaze and place it between those fingers to prevent maturation of the skin. Start wrapping around the fingers working down and around the palm, tare or poke a hole as needed to, to accommodate the thumb, but continue wrapping the wrap roll nice and easy no pulling or tension. Providing adequate cushioning around any bony prominences or areas of swelling and we continue down to the antecubital fossa.

Measure out the necessary length of plaster slabs and tear it to suit. You want eight to ten layers. Dump the plaster slabs in a bucket of warm water squeeze out excess water by compressing the material according to the style.

Apply the paster starting with the fingers. Mold them conform with the fingers and hand and fold the material into a gutter shape. Don't forget to hold that Z. All of the plaster surface must be covered as the gauze is wrapped around. Remember the patient must be maintaining the hand in that Z position for proper healing. Even if it's uncomfortable. If the patient moves you will see cracks and pressure points appearing at the distal crease and wrist.


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