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Application of Backslab

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.

Aim: To introduce to the uses and method

of applying back slab. Back slab can

improve patient’s comfort, provide

stability and maintain reduction in

limb.

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

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