Lesson 1Indications and contraindications for below-elbow casts and removable wrist bracesThis lesson explains when to use below-elbow casts or removable wrist braces for distal radius fractures, including fracture stability, patient factors, and cases needing other immobilization or surgery consultation.
Stable versus unstable fracture featuresAge and activity level considerationsContraindications to circumferential castingWhen to prefer removable wrist bracingRed flags requiring orthopedic referralShared decision-making with patientsLesson 2Anatomy of distal radius, pediatric/adolescent bone physiology, and fracture healing timelinesThis lesson reviews distal radius anatomy, growth plate features, and bone physiology in children and adolescents, linking them to fracture patterns, remodeling, and healing timelines that guide immobilization and follow-up.
Osteology of distal radius and ulnaPhyseal anatomy and growth contributionPediatric cortical and cancellous bone traitsCommon distal radius fracture patternsRemodeling potential by age and planeExpected healing timelines by ageLesson 3Materials and equipment list: stockinette, cotton/padded rolls, plaster vs fiberglass properties, water temperature, casting scissors and sawsThis lesson covers essential casting materials and tools, comparing plaster and fiberglass, padding sizing, safe water temperatures, and proper use of scissors, spreaders, and oscillating saws in practice.
Stockinette sizing and applicationPadding selection and layering techniquePlaster versus fiberglass characteristicsWater temperature and setting controlSafe handling of scissors and spreadersOscillating cast saw safety principlesLesson 4Positioning and molding technique: wrist position, forearm rotation, elbow position, and acceptable angulationThis lesson describes best positioning for wrist, forearm, and elbow in distal radius fracture casting, including acceptable angulation, and molding principles to keep reduction while allowing function and comfort.
Functional wrist flexion and extension anglesForearm rotation for different patternsElbow position and patient comfortAcceptable angulation by age and planeThree-point molding over fracture siteAvoiding rotational malalignmentLesson 5Immediate post-application checks: capillary refill, finger mobility, pressure point assessment, comfort and fitThis lesson outlines checks right after applying immobilization, covering perfusion, motor and sensory function, pressure points, and cast fit to spot early issues and ensure safe, comfortable support before leaving the clinic.
Capillary refill and skin color assessmentActive and passive finger motion testingSensory screening of median and ulnar nervesPalpation of bony and soft tissue pressure pointsAssessment of cast edges and overall fitDocumentation and communication of findingsLesson 6Patient education: cast care, moisture and hygiene precautions, activity and lifting guidance for dominant hand injuriesThis lesson provides guidance for teaching patients and caregivers about cast care, avoiding moisture, managing itch, safe activities, lifting limits for dominant hand injuries, and when to seek urgent help.
Daily cast inspection and skin careMoisture, bathing, and swimming precautionsManaging itch and avoiding foreign objectsActivity restrictions and lifting limitsReturn to school, work, and sports timingWhen and how to seek urgent reviewLesson 7Types of below-elbow immobilization: short arm plaster cast, short arm fiberglass cast, volar wrist splint, removable wrist brace — design and biomechanical effectsThis lesson explores below-elbow options for distal radius fractures, describing construction, indications, and effects of short arm plaster and fiberglass casts, volar splints, and removable braces on motion and comfort.
Short arm plaster cast designShort arm fiberglass cast designVolar wrist splint indicationsRemovable wrist brace indicationsControl of flexion, extension, and rotationImpact on function and daily activitiesLesson 8Step-by-step application of short arm plaster and fiberglass casts with key technical tips for padding and three-point moldingThis lesson gives a step-by-step guide to applying short arm plaster and fiberglass casts, focusing on padding, overlap, avoiding wrinkles, three-point molding, and tips to prevent sores and maintain reduction.
Preparation of materials and patient positioningStockinette and padding application detailsPlaster bandage application sequenceFiberglass bandage application sequenceThree-point molding over fracture apexFinal inspection and edge trimmingLesson 9Warning signs and urgent review criteria: increasing pain, numbness, swelling, tight cast, smell or dischargeThis lesson defines warning signs needing urgent review after immobilization, like worsening pain, numbness, swelling, odor, discharge, or cast damage, with triage advice and documentation duties.
Disproportionate or increasing painNew numbness, tingling, or weaknessProgressive swelling or tight cast feelingSmell, discharge, or cast softeningCast cracks, dents, or loose fitTriage instructions and documentationLesson 10Follow-up schedule and radiographic check timing, cast removal considerations, graduated mobilization and referral to physiotherapyThis lesson covers follow-up intervals, radiograph timing for reduction loss, criteria for cast change or removal, and planning gradual mobilization, strengthening, and referral to physiotherapy or hand therapy.
Initial post-casting review timingRadiographic schedule and viewsMonitoring for loss of reductionCriteria for cast change or wedgingSafe timing of cast removalStaged mobilization and therapy referralLesson 11Pre-application clinical checks: skin, swelling assessment, neurovascular exam, compartment syndrome signsThis lesson explains pre-application assessments, including skin check, swelling evaluation, neurovascular exam, and spotting compartment syndrome signs that may change immobilization plans.
Inspection for wounds and skin compromiseAssessment of swelling and soft tissue statusBaseline motor and sensory documentationPeripheral pulses and capillary refillEarly signs of compartment syndromeDeciding to delay or modify casting
