Lesson 1Indications and contraindications for below-elbow casts and removable wrist bracesExplains when below-elbow casts or removable wrist braces suit distal radius fractures, detailing stability criteria, 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 timelinesExamines distal radius anatomy, growth plate details, and young bone physiology, connecting these to common fracture types, remodelling ability, and healing times that inform immobilization and follow-up decisions.
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 sawsLists key casting materials and tools, contrasting plaster and fiberglass features, padding sizes and layers, 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 angulationOutlines best positioning for wrist, forearm, and elbow in distal radius casting, including allowed angulation, and describes molding techniques to hold reduction while keeping function and comfort intact.
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 fitDetails checks right after applying immobilization, covering blood flow, movement and sensation in fingers, pressure spots, and cast fit to spot early issues and ensure safe, comfortable support before leaving.
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 injuriesOffers clear advice for patients and caregivers on cast maintenance, avoiding moisture and hygiene tips, managing itch, safe activities, lifting limits for main hand injuries, and when to seek quick 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 effectsDiscusses below-elbow options for distal radius fractures, covering build, uses, and effects on movement and comfort of short arm plaster/fiberglass casts, volar splints, and removable braces.
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 moldingGives a step-by-step guide for applying short arm plaster and fiberglass casts, stressing padding methods, overlaps, wrinkle prevention, three-point molding, and tips to avoid sores and hold position.
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 dischargeIdentifies warning signs needing urgent check after immobilization, like rising pain, numbness, swelling, bad smell, discharge, or cast issues, with triage tips and record-keeping 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 physiotherapyReviews follow-up times, x-ray schedules to check reduction, reasons for cast change or removal, and plans for gradual movement, strengthening, and physio or hand therapy referrals.
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 signsCovers key checks before applying, including skin condition, swelling review, nerve and blood vessel exam, and spotting compartment syndrome signs that might 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
