Upper limb slabs, broad arm sling and ayalew - Copy.pptx

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 8

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

19. 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.

20. 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

21. 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.

22. 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.

23. 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).

24. 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.

25. 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.

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27. 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.

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29. 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.

30. cont Ulnar Gutter Splint Radial Gutter Splint

31. 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 .

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

33. cont,.. T he 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

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

35. 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

36. 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

37. 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)

38. 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.

39. 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

40. 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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44. REFERRANCE Orthopaedic Office and Emergency Procedures Internet Emergency orthopedics

45. THE END THANKS!!!!!