Uppelimb slab presentation

1. Upper limb slabs, broad arm
sling and collar & cuffs
Presented by:
Mohamed Mohamud Farah(OR1)
MODERATER: Dr Kinfe Araya (Orthopedic & Trauma
Surgeon)

2. Out line
• Introduction
• Principles of splinting
• Types Splinting

3. INTRODUCTION
• NOM of # treatment remains the most
common
• Operative mgt accelerated after world war II
• virtually every fracture can be treated and has
been treated non operatively.

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• Indications for OM depend primarily on training
and biases of that community's fracture surgeons
• radiographic characteristics of the fracture help in
selecting treatment and evaluating outcome
• Anatomic realignment Vs acceptable•
reduction
• Acceptability of reduction is that the limb appears
normal by clinical evaluation to allow prompt
restoration of function with healing

5. Selection of Treatment
• Some fractures can be treated safely with
immobilization alone despite significant
angulation (e.g., humeral shaft, fifth
metacarpal fracture).
• Others require closed reduction when
displaced or angulated (e.g., Colles' fracture).
• And still others require consultation for
operative intervention (e.g., open fracture,
displaced scaphoid fracture).

6. Reduction
• Restoration of fracture fragment to acceptable position
• Aim for adequate apposition & normal alignment
• Two methods
• Conservative
– Closed reduction by manipulation
» Under anesthesia & muscle relaxant
– Continuous traction
» Skin traction
» Skeletal traction
» Gravity
• Open reduction (operative)
– Under direct vision

7. Maintenance of reduction
To keep the fracture fragment in acceptable
position
Methods
Cast, splinting
Continuous traction
Internal fixation
External fixation
• reduction under general or regional anesthesia so
that it can be gentle and need be performed only
once or twice

8. splint
• Splinting plays a major role in the management of
musculoskeletal injuries
• splinting
– decreases
• pain,
• bleeding and
• Compared with casts, splints permit swelling
– prevents further soft tissue, vascular, or neurologic
compromise
– Prevent closed# from becoming open
• Splinting may provide definitive treatment for some
injuries

9. EQUIPMENT
• Splints have traditionally been made of plaster of
Paris
• Recently:
– pre-formed plaster
– Fiberglass
– pre-padded fiberglass
– malleable aluminum
– air splints
– vacuum splints, and
– pre-formed "off-the-shelf" splints

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• The equipment necessary for the application
of splint includes:
1)Cotton bandage for padding
2) Plaster slabs or rolls or pre-padded
fiberglass splint material
3) Room temperature water
4) Elastic or roll bandage

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

13. BASIC PRINCIPLES
• Provide pain control, as needed
• Prepare all materials
• Remove ornaments
• Assess the full extent of the injury
• Adequate exposure for splint application
• account the patient's ability to remove clothing
• Ensure adequate and comfortable immobilization
• Appropriate size, weight, and shape
– Child: ~ one-half of the circumference of the extremity
– For adults, use
• 2 inch --finger splints
• 3 and 4 inch --upper extremity
• 5 to 6 inch widths for lower extremity

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• proper padding to Prevention of skin breakdown
• Immobilize the joints above and below a fracture unless this is not possible (such as for distal
fractures below the elbow or knee).
• Immobilize the bones above and below a dislocated joint unless this is not possible (such as for
distal fractures below the elbow or knee).
• splint the involved joints in their positions of function
• Never splint fractures circumferentially, particularly if the patient has impaired sensation, excessive
swelling, or circulatory insufficiency
• Evaluate neurovascular status before and after application
• Provide slings for added support or crutches to prevent weightbearing or use of the extremity.
• Provide aftercare instructions and ensure adequate follow-up
• Instruct the patient to return to the physician for evaluation of 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
• Check splints 24 to 48 hours after application
• another evaluation after 7-10 days
• Initiate physical therapy

15. Types Splinting
• Coaptation Splint :
Indication :The application of a coaptation
splint is most commonly performed in the
setting of a fracture of the humerus. It is the
easiest and most effective way to immobilize
the arm in an acute setting.

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• 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 in this
area. The splint courses along the medial
aspect of the arm, around the elbow, up the
lateral aspect of the arm, and over the
shoulder toward the neck

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• 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.
With the elbow bent to 90° and the forearm
supinated, apply the splint along the posterior
aspect of the arm, elbow, wrist, and hand, ending
at the metacarpal heads.

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• 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.

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• Volar Wrist Splint
Indication:A volar wrist splint is 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.

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• Dorsal Wrist Splint
Indication:A dorsal wrist splint is 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.

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• Ulnar Gutter Splint
• Radial Gutter Splint

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• Thumb Spica Splint
Indication:The Thumb spica splint is effective
in immobilization of the Thumb IP, MCP, and
CMC joint .
It is frequently applied in the setting of
fractures and dislocations involving the
scaphoid, thumb metacarpal. and thumb
proximal phalanx.

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• PIP and DIP Extension Splints
Indication: Extension splints of the finger are
used for immobilization of the DIP or PIP joint
either in isolation or in conjunction with the
other. The DIP extension splint is commonly used
for the mallet finger injury (extensor tendon
avulsion from the distal phalanx) or volar PIP
dislocation (implied central slip avulsion from the
middle phalanx).

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31. COMPLICATIONS OF SPLINTING
• Loss of reduction
• Sores
• abrasions, and possible infections from loose or ill-
fitting splints
• neurovascular compromise from tight-fitting splints
• contact dermatitis
• pressure sores
• thermal burns
NB: Most of these complications can be avoided

32. Dangers & Complications
Warning Signs – 6 P’s
• Pain
• Pallor
• pulseless
• Poikilothermia
• Paresthesia
• Paralysis
Check pulse at points distal to cast after application

33. Dangers & Complications
Prevention – “RICE”
R – Rest
I – Ice
C – Compression
E – Elevation

34. BROAD ARM SLING / SLING AND
SWATH
Though simple in form and principle, this sling is rich in
security, ease and comfort.”—W.C. Wermuth, MD, 1908
• 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

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• precautions
1. Ensure a proper fit to prevent pressure complications at the back of
the neck. 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.
2. If a reduction maneuver has been performed, obtain postreduction
radiographs while the patient is wearing the sling or the sling and swath
to ensure maintenance of the reduction.
• Equipment
1. Arm sling or sling and swath
2. Cast padding or ABD pad
3. Talcum powder (optional)
improvisation
An arm sling and 6-inch elastic bandage can be used if a commercial sling
and swath are not available.

36. Basic technique
• 1. Patient positioning:
a. Standing
• 2. Landmarks:
a. Clavicle
b. Acromioclavicular joint
c. Acromion
• 3. 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.

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39. 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

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• Application
– The arm should be relaxed when applied.
– Tension during fitting should not occur

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45. REFERRANCE
• UPTO DATE 20.3
• Orthopaedic Office and Emergency
Procedures 1E
• INTERNET

46. THANK
YOU