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Wilfredo C. Ciar
Shift Manager
Ain Al Khaleej Hospital
Application
of
Back slab
Backslab application:
1. Using the correct width plaster sheet (unrolled),
measure the length required longitudinally along the
limb.
2. Fold the plaster sheet to the required layers – layers
required vary by type of backslab.
3. Cut plaster sheet to size.
4. Immerse the plaster into the lukewarm water and
hold it under until the bubbles stop.
5. Drain the plaster until the drips stop (do not wring it
out)
6. Place the slab longitudinally in position over limb
(fold any un-neat edges).
7. Mold by rubbing it smooth.
8. Turn the ends of the webril/cotton roll back over the
ends of the plaster.
9. Unroll the gauze/crepe bandage circumferentially
around the limb to secure the plaster and free ends of
webril/cotton roll (roll layers should overlap by 50%).
Start distally and wrap proximally. Tape it to tie off the
bandage
10. Hold the limb in the correct position for approximately
5 minutes until the plaster hardens.
Initial dressing:
1. Apply the fabric stockinette over the limb to cover the area below the
plaster plus a couple of inches and cut to size – avoid wrinkles and cut
hole for thumb if needed (omit this in acute injuries).
2. Unroll the webril/cotton roll circumferentially around the limb to cover
the area below the plaster plus a couple of inches (roll layers should
overlap by 50%). Start with two initial rolls then progress distally/
proximally. Use double thickness for both plaster ends and any bony
prominences. Cut a hole/slit for the thumb if required. The end can be
left loose.
3. Extra squares of webril/cotton roll may be applied over any bony
prominences to avoid pressure sores.
Backslab layer requirement:
- Basic slab is 10 layers of plaster (ie. 5 sheets
measured to lengthand doubled over)
- Below elbow/above elbow slab
~ use 20 cm plaster for BIG arm
~ use 15 cm plaster for SMALL arm
- Below knee/above knee slab
~ use 20 cm for BIG leg
~ use 15 cm foe SMALL leg
- Scaphoid slab
~ back slab plus 5 layers for thumb spica
~ use 20 cm plaster for BIG arm
~ use 15 cm plaster for SMALL slab
Target: Registered Nurses working in Orthopedic
Clinic and Emergency Room. Auxiliary
Nurses on assisting in backslab application.
Equipment:
1. Stockinet – prevents arm/leg hairs from catching in plaster.
It helps conduct perspiration from the arm/leg. Makes
plaster more comfortable for patient.
2. Webril/Cotton or Wool roll – protect bony prominences.
protect limb from damage from plaster saw.
3. Plaster of Paris – a hemihydrated calcium sulphate
which solidifies when added to water.
4. Apron and Gloves
5. Crepe Bandages
6. Plastic Sheets
7. Bucket filled with lukewarm
water (the warmer the water
the faster the cast will set).
8. Heavy duty scissors, Tapes
- ensure fibular head is well padded with webril/cotton roll
- apply the plaster slab (15cm wide, 4 layers) along
posterior aspect of leg from middle of the thigh to the
toes (fold over a corner of plaster to expose little toe and
neatly fold excess plaster around ankles)
- mould by rubbing and smoothing it
- apply further plaster slabs ( 10cm shorter than main slab,
10cm wide, 4 layers) to the medial and lateral sides –
they should both cover the heel
On completion;
1. Thank patient and cover them.
2. Bin all waste and clean area.
3. For upper limb casts, apply a triangular or arm sling.
4. Review patient.
~ Once the backslab/cast set in, check:
- for sharp edges
- correct positioning
- comfort of the patient
- distal neurovascular assessment and tendon function
- post cast x-ray
~ 24 hours cast check
~ If problems arise e.g.
- pressure sores- a “window” can be cut in the cast
- infection – smelling the cast is a good indication.
5. Give the patient a leaflet and give plaster advice (including advising
to seek urgent medical help if limb is numb, painful, cold, discolored,
cast/backslab must be kept dry and that, for weight bearing lower limb
plaster cast, they must not weight bear for two days
6. Fully document in notes and sign cast prescription
7. Book follow up appointment.
Complication of Backslab:
1. Compartment syndrome
2. Ischemia
3. Heat injury
4. Pressure sore and skin breakdown
5. Infection
6. Dermatitis
7. Joint stiffness
8. Neurologic injury
Thank you...
Above knee
(long leg)
Backslab
position....
- extends from the middle of the thigh to
the base of the toes
- knee in 5 - 20° flexion
- ankle neutral
*cylinder cast variation = ends before
ankle
What your patient should know.
1. elevate or rest extremity with cast/slab on a pillow/cushion to avoid swelling
of fingers/toes. If swelling, discoloration or coldness is notice instruct
patient to return to Emergency Room or Fracture/Ortho Clinic
2. never use anything to scratch under the cast/slab. (the slightest scratch
could develop into infection.)
3. never trim or cut down the length of the cast/slab yourself or attempt to tuck
in extra padding
4. never let water sip into the cast/slab as this will weaken it.
5. do not walk or put weight with it, employ the use of crutches
6. do not try to drive with it.
7. do exercise to avoid stiffness on unaffected joints.
Upper extremity:
- wiggle your fingers
- bent and straighten your elbow joint (only if the plaster ends below
the elbow
- gently rotate your shoulder
Lower extremity:
- wiggle your toes
- bend and straighten your knee (only if the plaster ends below the
knee)
- gently clench the muscle in the back of your calf and thigh to improve
the blood flow.
condition....
- distal humerus/patella
fracture
- tibia and fibula facture
- tibia fracture
position.....
- extend from middle of upper arm to just proximal to the knuckles on the dorsum of
the hand and the distal crease on the palmar aspect
- elbow at 90°
- forearm usually mild prone but should be in supination for proximal third radius fractures, and in pronation for distal third radius fracture
- wrist is usually neutral
condition....
indication..
position....
- cut a groove for the thumb before wetting
the plaster
- apply the plaster slab to the dorsal aspect
of the forearm and the dorsolateral aspect
of the wrist
- rub it smooth so distal radius is gently
gripped
position....
- extends from 5cm below the olecranon to just proximal to the knuckles on the dorsum of the hand and the distal crease on the palmar aspect
- wrist is normally neutral but can be flexed and ulnar deviated (Colles cast variation for Colles’ fracture) or extended (for Smith’s fracture)
- Isolated distal radius
fracture
- Carpal fractures
Below elbow
(short arm)
Backslab
- apply extra layer of soft cotton wool around
elbow
- apply the plaster slab along posterior aspect of
arm, elbow and ulnar aspect of the forearm
down to knuckles
- make 5cm slits either side of the elbow crease
and overlap cut edges and smooth them out
- apply further plaster slabs to the medial and
lateral sides of the elbow and then smooth the
edges
Above elbow
(long arm)
Backslab
- apply the plaster slab (15cm wide, 4 layers) along posterior aspect of the leg from 5 cm below popliteal crease to the toes (fold over the corner of plaster to expose little toe and neatly fold excess plaster around ankles)
- apply further plaster slabs (10 cm shorter than main slab, 10 cm wide, 4 layers) to the medial and lateral side – they should both cover the heel - ensure fibular head is free (perianal nerve runs around this)
- extends from the tibial tubercle
to the base of the toes
- ankle neutral (90°)
- All radius/ulna fractures (except isolated distal radius fracture)
- distal humerus/humeral olecranon/epicondyle fracture
condition......
- calcaneus/talus
fracture
- Fibula fracture,
Ankle factures
Below knee
(short leg)
Backslab
Objectives:
1. Describe the indication and complication in
backslab application.
2. Identify materials used in backslab application.
3. List and explain the steps in applying backslab.
4. Know how to explain the “cast care” to the patient.
Patient’s positioning and exposure:
1. Expose the affected limb and remove any jewelry
2. Examined the injured extremity
a. Look for wounds and treat prior to applying cast
b. Examine neurovascular status
c. Reduce the fracture or dislocation if required (to be done by
orthopedic doctor)
3. Position patient:
a. Below elbow backslab: patient sitting with elbow resting on
hard surface and hand slightly elevated.
b. Above elbow backslab: patient lying supine with arm off side
of bed and assistant holding the patient’s hand to support the
weight of the arm
c. Below knee backslab: patient sit on the edge of bed with lower
legs dangling off side or patient lying on his stomach with leg
bend upward.
d. Above knee backslab: patient lying supine with leg rest or
assistant holding holding leg in position or patient lying on his
stomach with leg bend upward.
4. Fully position limb in desired position
5. Apply large pads and plastic sheets around patient and limb to
collect spillage.
Conditions that indicates for backslab immobilization:
1. Fracture
2. Sprain
3. Severe soft tissue injuries
4. Reduced joint dislocation
5. Tendon laceration
6. Deep laceration repair across joints
7. Inflammatory conditions: arthritis,
tendinopathy, tenosynovitis