This document discusses casts and slabs for immobilizing musculoskeletal injuries. Casts fully surround the limb while slabs only partially surround. Casts provide better immobilization but have higher risks of complications like pressure sores. The document outlines indications, advantages, disadvantages and application steps for casts and slabs. It emphasizes the importance of monitoring for complications, starting physiotherapy early, and removing the cast or slab as soon as possible.

1. Cast & Slab
Dr. Ahmed Shedeed Abdel Ghaffar
Resident of Orthopaedics
Railways Hospital
Member of AOTrauma foundation
Member of Egyptian Orthopaedic Association
dr.ahmedshedeed@yahoo.com

2. objectives
• Definitions
• Indications
• Advantages & disadvantages
• Steps of applying cast and slab
• Medical treatment and precautions

3. Cast & slab
are methods of a temporary immobilization for a wide
variety of musculoskeletal conditions not only for disorders
of bones but also for many other disorders related with
tendons , muscles and soft tissues
Cast : are circumferential immobilizers which is surrounding the
whole circumference of the limb
But
Slab : are non circumferential immobilizers which is only support
apart of the circumference of the limb

4. Cast
‫جبس‬
Indications : primary management of simple and stable
fractures
e.g :
Inplace scaphoid fracture
Inplace well reduced Colles fracture
Reduced fracture both bone forearm in pediateric
Isolated, nondisplaced uni malleolar potts fractures
Advantages : more effective immoplization with less probability of
displacement than slab it can also be used in some cases of post operative
internal fixation for initial support of the affected fixed limb

5. Disadvantages :
Casts provide better immobilization, but are less
forgiving as it doesn’t allow for swelling and can act as a
compressive force and irritating material for the skin so
it have higher complication rates:
ischemia
heat injury
pressure sores
skin breakdown
Infections
Dermatitis
neurologic injury
Joint stiffness
and compartment syndrome

6. Application of the cast
Types of the active
supstance of the cast
plaster fiberglass

7. Application of the cast
GENERAL PRINCIPLES
- It is important to maintain good anatomic fracture alignment
- Acceptable angulation which varies depending on the fracture site.
- You should active Fix Joint Above And Joint Below The Injury
Stable fractures are generally reevaluated within one week following cast
application to assess cast fit and condition, and to perform recent radiographic
studies to monitor fracture alignment.
Displaced fractures require closed reduction, followed by partial casting and
post-reduction radiography to confirm bone alignment then complete the cast
for the proper condition
If reduction or positioning displaced during the follow up , urgent rereduction
should be performed , reapply the cast and prepare the patient for operative
internal fixation.

8. Application of the cast
Steps of applying the cast to the limb
1- circumferential application of cotton padding

9. Application of the cast
Steps of applying the cast to the limb
2- circumferential application of plaster or fiber-glass

10. Application of the cast
Steps of applying the cast to the limb
3-Molding of the cast layer by layer

11. Application of the cast
Steps of applying the cast to the limb
4- Maintain the limb in the position of function

12. Application of the cast
Steps of applying the cast to the limb
5-placing the injured extremity in its position of function

13. Application of the cast
Steps of applying the cast to the limb
Finally You Should Assess the Pulse and Capillary
Refilling For the Casted Limb To Ensure That There’s No
Any Compressive Force Over The Vessels

14. Prescribe the medical treatment for the patient in
the form of
Analgesic & Anti Eadematous
And tell the patient about the important cautions to be monitored
1- Constantly make range of movements with the exposed fingers of
the casted limb to avoid the stiffness
2-Keep eyes on the edema and the color of the exposed fingers and go
to the emergency room quickly if there's bluish discoloration or sever
edema
3- essential limb elevation
4- Initiate the Proper Physiotherapy for the affected limb after
removing the cast
IT’S BETTER TO MAKE FOLLOW UP SHEAT FOR THE INJURED
PATIENT FOR BETTER MONITORING OF THE INJURY AND REGISTER
EVERY INCIDENT , CAUTIONS , AND THE TREATMENT
THIS IS NOT ONLY BETTER FOR THE PATIENT BUT ALSO FOR THE
DOCTOR AS A MEDICOLEGALITY

15. Slab
‫جبيرة‬
Indications : management of a variety of acute musculoskeletal conditions in
which swelling is occurred or anticipated, such as edematous fracture site ,
sprains, or for initial stabilization of reduced, displaced, or unstable fractures
up till orthopedic intervention
e.g : Ankle sprain
Swollen fractured limb
Preoperative mangment
Postoperative support
Open fractures
Advantages : More safe than the Cast as it allows for swelling with no
compressive force and give the chance for following up the wound in
compound fractures and the incision in post operative internal fixation
Disadvantages : less effective immobilization with more possibility for
dislacment

16. Application of the cast
Steps of applying the Slab to the limb
1- circumferential application of cotton padding

17. Application of the cast
Steps of applying the Slab to the limb
2- Take the length of the area you will apply the slab
as it fixes joint below and joint above the injury
3- Make 6 Double layer plaster slab for the upper
limb & 8 Double layer for the lower Limb

18. Application of the cast
Steps of applying the Slab to the limb
4- One Side application of plaster or fiber-glass

19. Application of the cast
Steps of applying the Slab to the limb
5- circumferential applying of crepe bandage (‫ضاغط‬ ‫رباط‬)

20. Prescribe the medical treatment for the patient in the form of
Analgesic & Anti Eadematous and range of movements for the
fingers of the affected limb
Initiate the Proper Physiotherapy for the affected limb after
removing the slab

21. Finally
Immobilization with Cast or Slab is a
race between the cure and the
complications so try as much as you
can to help the cure to win the race
before the complications , and this
will be achieved by good management
, monitoring the case and remove the
cast or slab as soon as possible .

22. Take Home Message
• Cast and Slab are primary initial management
with a high risk of failure
• Fix active joint above and joint below
• Assess pulse and capillary refilling after cast
• Antiedematous drugs are very important
• Monitoring and follow up are mandatory
• Cast and Slab are easy procedure but you should
respect their complication
• Remove as soon as possible
• Start physiotherapy as soon as possible