3 Limb Casts: Components and Team Roles

• Limb casts are used for: fracture stabilization, surgical fracture repair protection, joint immobilization, and tendon laceration limb support and wound healing.

Cast Components

• Stockinette: A thin, double-layer sock-like lining between the limb and cast material.
• Orthopedic felt: A 0.5-1cm thick felt strip protects high-pressure areas prone to rub sores.
• Cast padding: Rolls of cotton or synthetic material shield and pad the limb.
• Cast tape: Typically woven fiberglass tape with water/air-activated resin ensures hardening; woven cotton with Plaster of Paris is also an option.
• Acrylic or Epoxy: Rigid synthetic material to support the bottom of the cast and prevent patient wear through the cast.
• Three types of cast padding: DeltaDry (woven synthetic material), Gore ProCell (Teflon foam in square cells), and specialist cast padding (loose cotton and rayon mixture).
• Resin Impregnated Woven Fiberglass Rolls of Cast Tape width ranges from 2” to 5”

Cast Team Roles

• Cast applicator: Team leader; experienced in material application and directing team members.
• Material handler: Experienced technician or doctor preps/hands materials to the team leader, and can act as second in command.
• Horse handler: Keeps the horse still and team safe.
• First assistant: Assists as needed, directed by team leaders.
• Additional assistants: Help handle materials or stabilize the leg during casting, crucial in challenging situations but not required for every application.

Application of the Cast: Patient Preparation

• All wounds or repaired incisions should be cleaned and dressed appropriately.
• Clean hair and remove debris, but leave as much hair as possible for extra protection.
• Bandage vulnerable areas to prevent rub sores; elastic tape over wound dressings act as a protective layer.
• Clean, trim, and dry the hoof.
• Antiseptic medication can be applied to the frog sulci.
• Elastic tape can extended to cover areas of likely cast sore development

Application of the Cast: Limb Positioning

• If the horse is standing, proceed with sedation.
• Use sufficient sedation without over-sedating or under-sedating them.
• Ensure they are standing squarely, and place the opposite limb solidly on a block.
• The casted limb positioned with the heels over the edge by ~1/3 of the hoof, while on a block.
• Should anesthesia be used, align the limb in a weight-bearing position, typically with a chosen fetlock/phalangeal posture.
• Positions include normal weight bearing, slight extension of fetlock and coffin joints, or toe-touching.
• Secure the hoof using a wire and handle, grasping the toe with an instrument, or manually aligning it with an assistant's hands.

Necessary Cast Materials

• Wound dressing
• Disposable Latex/Nitrile Gloves
• Scissors
• Stockinette
• Orthopedic Felt
• White Athletic Tape
• Cast Padding
• Cast Tape
• Water basin or bucket with warm water
• Hoof Acrylic
• Mixing Utensils & Tin Foil

Hoof Cast

• Use it for compromised hoof capsules that need stabilization with cast tape not contacting the skin
• It can be applyed temporarily util farrier arrives, or as a stabilization method.

Foot Cast (AKA Phalangeal Cast)

• Commonly used for managing heel bulb lacerations.
• It improves tissue stability, supports laceration repair, reduces owners effort, reduces costs and accelerates healing compared bandage costs while improving cosmetic resolution.

Foot Cast Application

• Place the horse as desired, but in a weight-bearing postion.
• It involves the use of stockinette being appliied above the fetlock, felt being applied to the heel bulbs and the proximal pastern,
• The cast padding is 1/2 to one roll used during the process with extra rolls available as an option
• The cast tape is the submerged in warm water before usage - Warmer = faster setting; Cooler = slower setting
• Follow manufacturer instructions for submersion time & squeezing instructions
• The narrowest tape is applied first, with subsequent rolls submerged as the prior is applied
• The edges are aligned with the top of the orthopedic felt - the initial wrap proceeds distally with around 50% overlap
• Attention to limb contours, and avoidance of winkles /dog ears is considered
• It is important the area is wraped under the heals and the stockinette is rolled down at this point.
• It is then continued to be appliied proximally, align with the proximal edge while changing roles as needed where left off
• Water applied to fully wet the cast tape may be normal for the inner part of the 2nd or 3rd roll.
• The lib position must be maintained until the cast is hardened
• The 5" Cast Tape is submerged while it'e applied
• Pick up the lib for 3 circumferential wraps, then crisscross over solar surface
• The cast material is flattend to ensure smoothness until fully cured
• Acrylic must be mixed and applied to the bottom with consistency to not be to runny, the mixture uses aluminum foil to cover
• The acrylic is allowed to cure before setting down the foot, after wards, elastic tape is applied on both the top to seal the cast abd the bottom to imprve grip.

Half Limb Cast

• Prepare stockinette, cast padding, felt for proximal cast & heel bulbs, and cast tape materials
• Stockinette: one 4” piece long enough to cover carpus/tarsus
• Padding: 1-2 rolls
• Felt: for the proximal cast and heel bulbs
• Tape: select one 3", three 4", & two 5" or four 4” & two 5" rolls

Half Limb Cast Application

• Dress and cover any wounds or incisions, then apply a double layer of stockinette ≈ 3-6” proximal to the intended top of the cast.
• The half limb cast ends at the proximal metacarpus/metatarsus, just below the joints/at head of splint bones.
• Apply orthopedic felt circumferentially without overlap at the intended top of the cast and over the heel bulbs.
• Hoof/limb stabilization starts with a wire through holes
• The wire may be wired dorsally which is still effective nonetheless, though creating a separation between the twitch and the heels.
• Position the limb in a normal weight-bearing location with the front limb being square to the sternum, and rear limb aligned by joints.
• After limb stabilization, apply cast padding with a 50% overlap over skinned areas and heel bulbs, then submerge tape to use.
• The top edge can be aligned wit felt as long as you leave a small ammount exposed.
• Do one wrap until an overlap of 50% is set with no tension added or applied, moving quickly.
• Be weary of winkles in pastern/foot
• To secure, wrap underneath the heels, and begin the second tape layer
• Be cautious and aware to align the top edge.
• Allow material to cure after application complete, the remove, and the tape.
• A protective layer can be applied to the sole of the cast, be aware of improverd mechanics during ambulation
• It can increase risk of cast sore on dorsal proximal if not done correctly.
• It is important, that the acrylic is allowed to fully cure while applying with elstic tape to seal and tract around the foot.

Bandage Cast

• Used for managing wounds in high motion areas, providing support and incision protection while requiring frequent bandage changes.
• Bandage casts can be split into halves (bi-valved), and saved as a custom-made splint
• They're easier and safer to apply than casts, offer less contour to the limb and bandage protects it from cast material.
• Insufficient Immobilization comes from downside/bandage material compresses and allows limb movement.

Bandage Cast Application

• It involves the appliication that is dressed with the deisred abndage
• The bandage is applied such that it can consistently be re-applied
• Wet and apply cast tape at top of bandage while submerging the second roll immediately
• Coninue distally with 50& overlap until you are ready to reverse course and move proximally once bottom is reached.
• Add more of the cast tape, approx 1 1/2 inch around 6 layers.
• It can removed and reapliled with a nonelstic tape or left until the first bandange change with a cast saw.
• With alternatives that consist of a OBC wire wthreaded through IV tubing, followed by removal, replilation and securation with nonelastic tape, and use of zip ties by some.

Full-Limb Cast

• Prepare the stockinette, cast tape, and felt for bones, with 3 and 4 roll padding.
• Prepare the One 4" stockinette with enough space to cover elbow/stifle for bony prominences.
• Apply the felt to the the bones, or 'doughnut' cuts over those bones.
• The approach is simiraly with a 4" tape in desired postion with felt and cast padding.
• Submurge the cast tape during application, and align to top, allowing no space between.
• After 6 to d layers ahve beeen applied. It is allowed to cure and the tape is wrapped distally with overlap in all areas.
• Heels also recieves some.
• In high tress areas such as carpus (knee area if front foot) increase overlaps for extra strength.

Cast Application-Adding a hell wedge

• Method that is used alternative to the twitch handle.
• Used for feet, limb casts.
• It is used for placing the horse in toe-touching positions with dorsal cortical alignment.
• Starts with removing the core from a cast tape
• Compress and palce at the bottom of the horses sole.
• It is then compressed into the sole of the shoe, with the top and botside being held together.
• It can incorporate into the initial application and lookin in the heels.

Cast Management and Complications

• Casts meant to be in a dry, clean location.
• Use in a stall, monitor and hear for squeaks with could idincate breakage.
• The animal ahoulbd be comfortable with ability of cleaning foot.
• Can monitor for mosity or debris at the top of the cast.
• Change elastic every 2 - 3 days to maintain.
• Check dorsal at top of cast often because areas prone to source.
• Place where this will also occur: helss, palmar, planar etc.

Cast Removal

• Removal steps are most likely done when sedated while standing.
• Start by drawing a line medially and laterally to make halves.
• Place the press oscillating saw into cast
• Ensure and recognize resistance is felt for throughness
• Saw that is lifted with 1 and 1/2 space wide while distalling the cast.
• Double check previously cut is opened enough from sides before taking to next area.
• This area needs to have its acrylic chiselled down if is required.

With a screw driver you check:

• If the blade is inserted parallel with cut- the gap will open.
• If that doesnt occure, then the acst needs to be adjusted and more reacuet
• The soels need to be fully cut.
• Use assistantd to pull halves if needed
• If thiers a tough part use screwes and spread
• Can use cranial assistant to pull cranially and caudally for more distance.