Name of the Procedure:

Cast Supplies, Gauntlet Cast (Includes Lower Forearm and Hand), Pediatric (0-10 Years), Plaster (HCPCS Q4015)

Summary

A gauntlet cast is used to immobilize the lower forearm and hand in children aged 0-10 years. This cast is made of plaster and helps in the healing of fractures or other injuries by keeping the affected limb stable.

Purpose

The gauntlet cast is primarily used to treat fractures and severe sprains of the lower forearm and hand in pediatric patients. The goal is to keep the bones in the correct position, facilitate proper healing, and reduce pain and swelling.

Indications

• Fractures of the radius, ulna, or bones in the hand
• Severe sprains or ligament injuries
• Post-surgical immobilization
• Conditions requiring limb immobilization for proper healing

Preparation

• No specific fasting is required.
• The affected limb may be X-rayed to diagnose the exact injury.
• The child should wear comfortable clothing that can be easily rolled up or removed.
• Parents should inform the healthcare provider of any allergies, especially to plaster materials.

Procedure Description

1. Initial Assessment: The healthcare provider examines the injury and may order an X-ray.
2. Positioning: The child’s arm is positioned correctly to ensure proper alignment.
3. Applying Padding: Soft padding is wrapped around the arm from the fingers to just below the elbow.
4. Plaster Application: Wet plaster strips are wrapped around the padded area, covering the lower forearm and hand.
5. Molding the Cast: The healthcare provider molds the plaster to ensure it fits snuggly but comfortably.
6. Drying: The plaster dries and hardens, usually within 20-30 minutes.

Duration

The entire procedure typically takes 30-45 minutes.

Setting

The procedure is usually performed in an outpatient clinic, hospital emergency room, or pediatric orthopedic clinic.

Personnel

• Pediatric orthopedic specialist or general healthcare provider
• Certified casting technician or nurse
• Radiologist (if X-rays are needed)

Risks and Complications

• Skin irritation or sores from the plaster
• Allergic reaction to plaster materials
• Swelling or circulation issues if the cast is too tight
• Delayed healing if the cast is not applied correctly

Benefits

• Proper immobilization aids in the correct healing of fractures.
• Pain relief as the bones are kept stable.
• Reduced risk of further injury to the affected area.

Recovery

• The child should keep the cast dry and avoid putting weight on it.
• Parents should monitor for signs of tightness, pain, or skin issues.
• Follow-up appointments will be needed to assess healing and possibly change the cast.
• Typical recovery time varies but often ranges from 4 to 8 weeks.

Alternatives

• Fiberglass casts: Lighter and more water-resistant than plaster but more expensive.
• Splints or braces: Less restrictive and easier to remove but may not provide the same level of immobilization.
• Surgery: In severe cases, surgical intervention may be necessary, often followed by cast application.

Patient Experience

• The child may experience some discomfort during the application as the plaster feels cold and wet initially.
• There should be minimal pain during the procedure, but pain management options can be discussed if necessary.
• Post-application, the cast may feel heavy and awkward, but most children adapt quickly.
• Itching under the cast is common and should be managed by keeping the area dry and avoiding inserting objects into the cast.