Name of the Procedure:

Application, cast; hand and lower forearm (gauntlet)

Common name(s): Gauntlet cast application
Medical term: Application of a gauntlet cast for the hand and lower forearm

Summary

A gauntlet cast is a rigid protective covering applied to the hand and lower forearm to immobilize them, usually following fractures or surgery. It helps in promoting proper alignment and healing of the bones.

Purpose

The procedure addresses broken bones, severe sprains, post-surgical immobilization, or other injuries to the hand and lower forearm. The goal is to stabilize the affected area, alleviate pain, prevent further injury, and promote proper bone healing.

Indications

• Hand or lower forearm fractures
• Severe sprains or ligament injuries
• Post-surgical stabilization
• Conditions requiring prolonged immobilization

Patient criteria: Typically an appropriate procedure for individuals presenting with acute hand or lower forearm trauma or those recovering from surgery in the specified area.

Preparation

• No fasting is usually required.
• Patient should inform the physician about any medications.
• Any diagnostic imaging like X-rays may be required to assess the injury prior to application.

Procedure Description

1. Initial Assessment: The injured area is examined and any necessary imaging is reviewed.
2. Padding and Lining: Soft padding and cotton lining are wrapped around the hand and lower forearm to protect the skin.
3. Casting Material: The plaster or fiberglass casting material is soaked in water to activate it and then wrapped over the padding, from the hand up to below the elbow.
4. Molding and Setting: The cast is carefully molded to fit the contours of the hand and lower forearm, ensuring immobilization. It takes a few minutes to set.

Tools/Equipment: Soft padding, cotton lining, plaster or fiberglass casting material, water for activating casting material.

Anesthesia: Generally not required for cast application unless the patient has recently undergone surgery and is recovering from anesthesia.

Duration

The entire process typically takes about 30-45 minutes.

Setting

The cast application is usually performed in an outpatient clinic or emergency department.

Personnel

• Orthopedic surgeon or physician
• Medical assistants or nurses

Risks and Complications

Common risks:

• Skin irritation or pressure sores
• Stiffness of the joints

Rare risks:

• Compartment syndrome (increased pressure in the muscles)
• Infection under the cast

Management of complications includes loosening or removing the cast and addressing the specific issues.

Benefits

• Proper alignment and stabilization of fractured bones
• Pain relief and prevention of further injury
• Improved healing outcomes Benefits are typically realized within a few weeks, with progressive improvement over time.

Recovery

• Keep the cast dry and clean.
• Elevate the limb to reduce swelling.
• Avoid heavy use of the affected hand.
• Follow-up with the physician for cast removal, usually after 6-8 weeks.
• Physical therapy may be recommended post-cast removal.

Alternatives

• Splinting: Less rigid than casting and allows for some movement.
• Surgery: In cases of complex fractures, surgical intervention may be necessary.

Pros of casting: Best for ensuring rigid immobilization. Cons: Less flexibility compared to splints, potential for skin issues.

Patient Experience

During the procedure, slight discomfort might be felt while the cast is being applied, but it is generally well-tolerated. Afterward, the patient might experience some initial stiffness and itching beneath the cast. Pain can be managed with over-the-counter pain relievers, and comfort measures include keeping the limb elevated and protected from moisture.