SLAB APPLICATION

IHSAN OESMAN MD
ORTHOPAEDIC DIVISION
UNIVERSITY OF INDONESIA
 SLAB/ SPLINTING

 Temporary Immobilization the injured part of the

body during transportation ( fracture, dislocations
and soft tissue injury )
 Can be ready made or can be made from basic
material ( gips/plester of paris or fiberglass )
 Support or protect the injured site during the healing
period ( 24 – 48 hours after injury ).
 Splints are easier to apply, allow for swelling and
reexamination
 SLAB FUNCTION

 Fracture immobilization
 Bone and joint disease immobilization
 To prevent musculoskeletal deformity
 To correct musculoskeletal deformity
 INDICATIONS

 Fractures
 Sprains
 Joint infections
 Tenosynovitis
 Acute arthritis / gout
 Lacerations over joints
 Puncture wounds and animal bites of the hands or
feet
 FRACTURE IMMOBILIZATION

 Emergency cases  adequate immobilization

and easy to contour
 To ensure the bone healing process without any
complication
 Temporary ( oedema reducing ) or definitive
treatment
 Conservative treatment to gain optimal
outcomes
 Maintain skeletal anatomical alignment
 Can be treated by a general practioner
 BONE & JOINT DISEASE IMMOBILIZATION

 Infection cases
 Provide rest to a joint by relieving
stress in infected area to gain optimal
healing
 to maintain in optimal position during
healing process
 OTHER FUNCTIONS

 Serial plaster to correct children

musculoskeletal deformity
 Assist in muscle reeducation and
exercise
 Assist weak movement from injured
part
 BASIC MATERIAL ( GIPS )

 Made from gypsum ‐ calcium sulfate dihydrate

 Exothermic reaction when wet ‐ recrystallizes (can burn
 patient)
 Warm water ‐ faster set, but increases risk of burns
 Fast drying ‐ 5 ‐ 8 minutes to set
 Extra fast‐drying ‐ 2 ‐ 4 minutes to set ‐ less time to mold
 Can take up to 1 day to cure (reach maximum strength)
 Upper extremities ‐ use 8‐10 layers
 Lower extremities ‐ 12‐15 layers, up to 20 if big
person (increased risk of burn!)
 FIBERGLASS

 Cures rapidly (20 minutes)

 Less messy
 Stronger, lighter, wicks moisture better
 Less moldable
 More expensive
 Much shorter shelf life than plaster
 Ready Made Splinting Material

 Plaster
– 10 ‐20 sheets of plaster with padding and cloth cover
 Fiberglass
– Sheets with synthetic padding
 Prefabricated splints and casts
– Plastic/metal
– Some are very fancy (and expensive)
 Splinting material characteristics

• Thermoplasticity • Rigidity
• Elastic Memory • Moisture
• Conformability permeability
• Flexibility • Finish

• Durability • Color
 Splinting Equipment

 Stockinette
 protects skin, looks nifty (often not necessary)
 cut longer than splint
 2,3,4,8,10,12-in. widths
 Padding - Webril
 2-3 layers, more if anticipate lots of swelling
 Extra over elbows, heels
 Be generous over bony prominences
 Always pad between digits when splinting hands/feet or when
buddy taping
 Avoid wrinkles
 Do not tighten - ischemia!
 Avoid circumfrential use
 Elastic bandage
 Poligips ( 3,4 and 6 inches )
 Splinting equipment

 Splint room
 The operator
 Apron
 Water
 Arm sling
 Medical record
 General Principles of Splint Application

 Measure the splinting length by using hand or device

 Apply the stockinette and padding
 Apply the polygips  8-12 layers for upper extremity
and 20 layers for lower extremity
 Hold the slab on 2 both edge and put into the water
until the air bubble was diminished
 Hanging the slab out of the water
 Apply the slab on the padding
 Hold and mould the slab until its texture running dry
 Specific Splints and Orthoses

Upper Extremity  Lower Extremity

 Elbow/Forearm • Knee
 Long Arm Posterior – Knee Immobilizer /
 Double Sugar - Tong Bledsoe
 Forearm/Wrist – Bulky Jones
 Volar Forearm / Cockup – Posterior Knee Splint
 Sugar - Tong • Ankle
 Hand/Fingers – Posterior Ankle
 Ulnar Gutter – Stirrup
 Radial Gutter • Foot
 Thumb Spica – Hard Shoe
 Finger Splints
UPPER EXTREMITY
 Long Arm Posterior Splint
 Indications
 Elbow and forearm injuries:
 Distal humerus fx
 Both-bone forearm fx
 Unstable proximal radius or
ulna fx (sugar-tong better)
 Doesn’t completely
eliminate supination /
pronation -either add an
anterior splint or use a
double sugar-tong if
complex or unstable distal
forearm fx.
 Double Sugar Tong

 Indications
 Elbow and forearm
fx - prox/mid/distal
radius and ulnar fx.
 Better for most
distal forearm and
elbow fx because
limits flex/extension
and pronation /
supination.
Forearm Volar Splint aka ‘Cockup’ Splint
 Indications
 Soft tissue hand / wrist
injuries - sprain, carpal
tunnel night splints, etc
 Most wrist fx, 2nd -5th
metacarpal fx.
 Most add a dorsal splint
for increased stability -
‘sandwich splint’ (B).
 Not used for distal radius
or ulnar fx - can still
supinate and pronate.
 Forearm Sugar Tong

 Indications
 Distal radius and
ulnar fx.
 Prevents pronation /
supination and
immobilizes elbow.
 U - slab

 Indication fo mid shaft

humeral fracture
 10 layers of 4 inches
polygips
 Fixed in 90 degrees
elbow flexion
 Padding  arm pit to
medial part of the
clavicle
 4 – 6 weeks
 Anterior slab

 For metacarpal fracture,

distal radial fracture,
extensor tendon rupture
 8 – 12 layers of 4 inches
gips
 15 degrees of ulnar
deviation and 20 degrees
wrist dorsiflexion
 Distal palmar crease to
5cm below elbow
 4 – 6 weeks
 Posterior slab

 For flexor tendon

rupture
 8 – 12 layers 4 inches
gips
 30 degrees MCP flexion
and 60 degrees wrist
dorsiflexion
 Metacarpal head to 2-3
cm below radial head
 4 – 6 weeks
 Finger splints

 Sprains - dynamic
splinting (buddy
taping).
 Dorsal/Volar finger
splints - phalangeal fx,
though gutter splints
probably better for
proximal fxs.
LOWER EXTREMITY
 Posterior slab
 Indications
 Distal tibia/fibula fx.
 Reduced dislocations
 Severe sprains
 Tarsal / metatarsal fx
 Use at least 12-15 layers of
plaster.
 Adding a coaptation splint
(stirrup) to the posterior
splint eliminates inversion
/ eversion - especially
useful for unstable fx and
sprains.
 Anterior slab

 Indications ( achilles tendon rupture, flexor tendon

rupture and muscle belly rupture )
 20 layers 6 inches gips
 30 – 55 degrees of foot plantar flexion
 Head of fibula to foot fingers
 4 – 6 weeks
 Stirrup Splint

 Indications
 Similiar to posterior
splint.
 Less inversion /eversion
and actually less plantar
flexion compared to
posterior splint.
 Great for ankle sprains.
 12-15 layers of 4-6 inch
plaster.
 complications
 Burns  Pressure sores
 Thermal injury as plaster dries  Smooth Webril and plaster well
 Hot water, Increased number of
 Infection
layers, extra fast-drying, poor
padding - all increase risk  Clean, debride and dress all wounds
 If significant pain - remove splint to
before splint application
cool  Recheck if significant wound or
 Ischemia
increasing pain
 Reduced risk compared to casting
but still a possibility
 Do not apply Webril and ace wraps
tightly
 Instruct to ice and elevate extremity
 Close follow up if high risk for
swelling, ischemia.
 When in doubt, cut it off and look
 Remember - pulses lost late
 THANK YOU

FOR YOUR ATTENTION