presentation on upper limb slabs

1. Upper limb slabs, broad arm sling and collar &
cuffs
By; Ayalew .k (or1)
Moderator: Dr Kinfe Araya (Orthopedic & Trauma
Surgeon)

2. Upper limb slabs, broad arm sling and collar &
cuffs
 Outline
 Introduction
 Principles of splinting
 Types Splinting

3. Introduction
A fracture is immobilized for three reasons:
 To permit healing,
 To relieve pain by rest, and
 To stabilize an unstable fracture.

4. Introduction
Cast splintage
POP (plaster of Paris) is hemi-hydrated calcium
sulphate
 Widely used as a splint in two forms
 Plaster slab
 Full plaster cast
 Indication
 As a splint for first aid Rx of #
 To hold # as definitive Rx
 Correct deformity
 Prevent pathological #

5. Introduction
 The fundamental rules of splints and casts are
identical.
 In general, the extremity should be placed in the
position of function before it is immobilized.
 Padding is provided to prevent pressure sores and
additional padding is applied to areas with bony
protuberances.

6. BASIC PRINCIPLES OF SPLINTS
6
 Expose the extremity completely before the splint is
applied.
 Remove ornaments
 Clean, repair, and dress skin lesions before applying
the splint.
 Immobilize the joints above and below the fracture .
 Immobilize the bones above and below the
dislocated joint .
 Never splint fractures circumferentially, if the
patient has impaired sensation, excessive swelling,
or circulatory insufficiency.

7. 7
 Evaluate neurovascular status before and after
application of the splint.
 Make the plaster wide enough to cover one-half
of the circumference of the extremity.
 Place Padding
 on the bony prominences;
 between the digits to prevent maceration;
 over the fracture site.
 To prevent stiffness and loss of function, splint
the involved joints in their positions of function.
 Use the patient's unaffected arm to approximate
the length of the splint.

8. Position the patient
 Pt should be sited
 Functional position
 Elbow 70-90⁰flextion
 Wrist 15-20⁰extention
 Forearm in neutral position
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9. Materials
 Cotton pads
 Plaster bandage
 Stockinet
 Water
 scissor
9

10. water
10

11. cotton
11

12. Plaster of paris
12

13. Plaster of paris
 15 cm for thigh
 10-15 cm for leg
 10-15 cm for arm
 5- 10 cm for forearm

14. Stockinet

15. scissors
15

16. Common Splinting Techniques
 LAS, SAS, LLS, SLS
 Sling
 Collar & cuff
 Sugar-tong
 Coaptation
 Ulnar gutter
 Volar / Dorsal hand
 Thumb spica
 Posterior slab (ankle) +/- U splint
 Posterior slab (thigh)

17. Upper limb slabs
Coaptation Splint
 Indication
 Fracture of the humerus.
Procedure
Extends from the axilla along the medial aspect of the
arm, around the elbow, and over the shoulder to at
least the level of the acromioclavicular joint,
preferably slightly longer

18. Coaptation Splint
 With the elbow bent to 90°, apply the splint as high
as possible in the axilla without causing discomfort or
compression of the sensitive soft tissue or
neurovascular structures
 Wrap the splint with bias, and apply the desired
mold

20. Long Arm Posterior Splint
Indication
 A long arm splint is most commonly used for
temporary treatment of injuries around or involving
the elbow.
 It is effective in immobilizing the wrist, forearm,
elbow, and a portion of the humerus.

21. Long Arm Posterior Splint
Procedure
 Extends along the posterior aspect of the arm and
forearm beginning just distal to the shoulder and
ending at the metacarpal heads.
 The forearm is routinely placed in neutral rotation;
however. it may also be placed in supination or
pronation

23. Single and Double Sugar-Tong Splint
Indication
 Both single and double sugar-tong splints are
commonly used for temporary treatment of injuries
around or involving the arm and wrist
 They are effective in immobilizing the wrist, forearm,
and elbow.
 While a double sugar-tong splint is considerably
heavier, there may be less of a tendency to slip off the
elbow.

24. Cont..
Procedure
 With the elbow bent 90° and the forearm in neutral
rotation, the lower, or "single;' portion
 should extend from just proximal to the metacarpal
heads at the first palmar crease on the palmar
surface of the hand, along the volar surface of the
forearm, around the elbow, and dorsally along the
forearm and hand to the distal most aspect of the
metacarpal heads.

25. Sugar-Tong Splint cont..
 After the plaster or fiberglass has set, the upper
portion can be applied if desired.
 The upper, or "double;' portion extends medially
from the axilla, around the elbow, and laterally as
proximal as desired (but at least as proximal as its
medial extent).

26. Sugar-Tong Splint cont…
 The upper, or "double;' portion of the splint can be
extended into a coaptation splint if shoulder
immobilization is necessary.
 With both a single and double sugar-tong splint, a
sling will help immobilize the elbow and prevent
slipping or breakdown of the splint.

29. Volar Wrist Splint
Indication:
 most commonly used for temporary treatment of
injuries around or involving the wrist.
 It is effective in immobilizing volar-dorsal and
radial-ulnar motion of the wrist and a portion of the
forearm.

30. cont

31. Dorsal Wrist Splint
Indication:
 most commonly used for temporary treatment of
injuries around or involving the wrist
 It is effective in immobilizing volar-dorsal and
radial-ulnar motion of the wrist and a portion of the
forearm.

32. cont

33. Cont..
 Similar to the volar wrist splint, the dorsal wrist
splint is most indicated in the treatment of;
 soft tissue injuries or extremely stable bony injuries.
 It is far inferior to both casts and sugar-tong splints
in maintaining reductions because it cannot be
effectively molded.

34. cont
 Ulnar Gutter Splint
 Radial Gutter Splint

37. Thumb Spica Splint
Indication
 The thumb spica splint is effective in immobilization
of the thumb IP, MCP, and CMC joint
 some coronal plane, sagittal plane, and rotational
control of the wrist and forearm.

38. Cont..
 It is frequently applied in the setting of fractures and
dislocations involving
 Scaphoid
 Thumb metacarpal and
 Thumb proximal phalanx.

39. cont,..
 The plaster or fiberglass should not be completely
circumferential around the thumb.
Procedure
 extends from the tip of the thumb along the radial
boarder of the hand, wrist, and forearm to just distal
to the elbow

41. Once applied..
Check
 No sharp edges
 Correct positioning
 Patient discomfort
 Distal NV status and tendon functioning
 X-ray

42. Cont…
 Instruct the patient to return if any
 numbness,
 tingling, or increased pain in the area underneath or distal to
the splint.
 To minimize swelling, ask the patient to keep the
extremity elevated, iced, and rested until
reevaluation

43. BROAD ARM SLING / SLING AND
SWATH
Indications
1.Sling:
a. Clavicle fractures
b. Minimally displaced proximal humerus fractures
c. Acromioclavicular separations
d. Support for splints and casts of the upper
extremity
2. Sling and swath:
moderately displaced proximal humerus fractures
where the humerus does not move as a single unit

44. Cont..
precautions
1. It is recommended that a well-padded sling be used or that
the neck be padded with cast padding and/or an Army Battle Dressing
(ABD) pad.
2. Elderly patients and patients with compromised skin (such as persons
taking steroids on a long-term basis) should be monitored closely for skin
breakdown.
pearls
1. The adult elbow does not tolerate immobilization well.
 If possible given the nature of the injury, the patient should be instructed
to perform daily elbow, wrist, and hand range-of-motion exercises.
Equipment
1. Arm sling or sling and swath
2. Cast padding or ABD pad
3. Talcum powder (optional)

45. Basic technique
 1. Patient positioning:
a. Standing
 2. Steps:
a. Sling:
(1) Have the patient stand.
(2) Fit the patient with a sling.
(3) The sling should provide support for the weight of the arm.
b. Sling and swath:
(1) Have the patient stand.
(2) Place an ABD pad with talcum powder (optional) in the axilla.
(3) Fit the patient with a sling.
(4) Apply the swath.

48. Triangular bandage rules
(Regardless of which sling type performing)
 Long side to un‐injured side of the body
 Opposite point to the injured elbow
 Always place arm bent above 90 degrees to allow
elevation (unless unable e.g. elbow injury)
 Secure at elbow to provide a ‘cradle’ for the arm

50. COLLAR AND CUFF
 Is a strap with a tubular neck pad and vinyl wrist
cuff is lined with comfortable flannel
 Indication
 For Rx of bone, muscular or ligament injuries to the hand,
arm, elbow or shoulder
 For arm support following surgical or non surgical procedures
 For first aid situations to support # or dislocations

51. cont

52. cont

53. cont

54. REFERRANCE
• Orthopaedic Office and Emergency Procedures
• Internet
• Emergency orthopedics

55. THE END
THANKS!!!!!