Clinical Procedures - Backslabs Plaster backslabs are used as immediate splints for fractures until definitive treatment is performed and are also used to protect the fracture fixation post-surgery. Equipment • Stockinette • Padding: • 10cm × 1 roll = above or below elbow backslab • 15cm x 2 rolls = below knee backslab • Plaster of Paris bandages • Bowl or bucket of water (lukewarm, 25-35°C) • Crepe bandage • Scissors. Risks • Circulatory and nerve impairment, compartment syndrome, pressure sores, joint stiffness. Procedure Tips • Backslab application is a 2-person procedure • Ensure the plaster fits well. A loosely applied cast will not provide adequate splintage and can rub, causing soreness • D Ensure the plaster does not cause constriction. In the early stages following fractures, the limb may swell, further restricting blood and nervous supply to the limb • Ensure bony prominences are adequately padded. Documentation • Date, time, indication, informed consent obtained • Neurovascular status of limb • Procedure performed • Plan of further management • Patient given instructions to contact staff if they experience increasing pain, if extremities change colour (e-g. become blue), or develop 'pins and needles' or numbness • Signature, printed name, and contact details. Procedure: Below Knee Used for fractures/dislocations at the ankle and fractures of the foot. • Use a padded knee rest if available to hold the knee at an angle of 10-15° • Hold the ankle at 90° with the foot in a neutral position • Cut a length of the stockinette from just below the knee to the toes and apply onto the patient • Apply a layer of padding over the stockinette: • The padding should extend from just below the knee to the toes • Start the padding from one end, rolling it around the limb evenly, overlapping half of the previous turn each time • Measure a slab of 10 layers of 15cm plaster of Paris from just below the back of the knee down to the base of the toes • Fold the plaster slab and dip it into the water holding the ends • Removed the plaster from the water, squeeze gently, and straighten it out • Fan out the upper end of the slab to fit the calf area • Place from just below the knee along the posterior surface of the lower leg, underneath the heel, and down to the base of the toes • Mould and smooth the plaster to fit the contours of the leg with the palms of your hands • Cut two side slabs 10 × 20cm long (length dependent on size of patient) made from 6 layers of plaster • Dip these in water and apply either side of the ankle joint: • A U-slab may be used instead of the side slabs. A 10cm wide U-slab (made of 6 layers of plaster) should be applied down one side of the leg under the heel of the foot and up the other side. Great care must be taken not to let the slabs overlap anteriorly • Finally, turn the stockinette back over the top and bottom edges of the plaster. Procedure: Below Elbow Used for fractures/dislocations at the forearm (including Colle's-type injuries) and fractures of the hand. • Cut a length of the stockinette from just below the elbow to the knuckles; cut a small hole for the thumb • Apply the stockinette to the patient • Apply a layer of padding over the stockinette: • The padding should extend from the elbow to the knuckles of the back of the hand and show the palmar crease, allowing flexion of the fingers • The thumb should be completely free • Start the padding from one end, rolling it around the limb evenly and overlapping half of the previous turn each time • Cut a length of plaster from below the elbow to the knuckles from a plaster of Paris slab dispenser 15cm or 20cm wide (dependent on size of patient), or by forming a slab from 15cm or 20cm plaster of Paris bandage using 5 layers • Fold the plaster and dip it into the water holding the ends • Removed the plaster from the water, squeeze gently, and straighten it out • Carefully position the slab on the limb over the padding from just below the elbow, down the dorsal surface of the limb to the knuckles • Mould and smooth the plaster to fit the contours of the forearm with the palms of your hands • Turn the stockinette back over the edge of the plaster cast at either end • Finally, apply the roll of crepe bandage over the plaster and the overturned stockinette to hold the plaster in place as it sets. Procedure: Above Elbow Used for fractures/dislocations at the forearm and elbow, also supracondylar fractures of the humerus. • Place the limb in a position of 90° flexion at the elbow • Cut a length of the stockinette from the axilla to the knuckles of the hand; cut a small hole for the thumb • Apply the stockinette to the patient • Apply a layer of padding over the stockinette: • The padding should extend from the axilla to the knuckles of the back of the hand and show the palmar crease, allowing finger flexion • The thumb should be completely free • Start the padding from one end, rolling it around the limb evenly and overlapping half of the previous turn each time • Prepare a 10cm or 15cm plaster of Paris slab (dependent on patient size), using 5 layers. The slab should be long enough to extend from the axilla to the knuckles of the hand • Fold the plaster and dip it into the water holding the ends • Removed the plaster from the water, squeeze gently, and straighten it out • Carefully position the slab on the limb over the padding running down the posterior surface of the limb over the back of the elbow • Mould and smooth the plaster to fit the contours of the forearm with the palms of your hands • Prepare two 10cm-wide slabs of 5 layers of 25cm length (adjust length according to size of patient). Place these on each side of the elbow joint to reinforce it • Turn the stockinette back over the edge of the plaster cast at either end • Finally, apply the roll of crepe bandage over the plaster and the overturned stockinette to hold the plaster in place as it sets.
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