Wednesday, April 21, 2021

Slab application

 Plaster of Paris Slab Application



The plaster slab extends from a point about 5 cm below the top of the olecranon to the level just proximal to the knuckles in the dorsum of the hand and the distal crease in the palmar aspect. 
• Apply a layer of dry gauze bandage around the forearm to just below the elbow


• 6-8 layers of 15cm width PoP is unrolled to the appropriate length as measured above

• Hold the folded plaster slab in the folded position and immerse it in water for about 5 seconds (until bubbles stop)

• Take it out of the water and gently squeeze out the excess water

• Apply the slab on the dorsal aspect of the forearm and the dorsolateral aspect of the wrist and rub it smooth so that the lower end of the radius is gently gripped by the slab

• Take a roll of 10 cm broad gauze bandage, soak it well in water and squeeze out the excess water

• Apply 10cm diameter wet bandage around the forearm, starting from the distal end to fix the slab
• The forearm is held with the elbow in a 90° flexed and the wrist in the position of function of 25° dorsiflexion

• The fingers should be free to move fully at the metacarpophalangeal joints and check capillary refill at the end of the procedure

**Stocky nets may not available in hospital supply


• The below knee plaster slab is applied in cases of injuries to the ankle and foot. 

• Extends from the level of the tibial tuberosity, posteriorly down the calf, ankle, heel and sole to the toes. Cover the area with a soft cotton roll

• Keep the foot in neutral position (ankle MUST be kept at 90°) 

• The rest of the procedure is similar to 'Below Elbow Slab'



• The patient's forearm is held in mid prone position with the elbow in 90° flexed position

• A layer of soft cotton roll is applied around the elbow

• A layer of dry gauze bandage is applied from the hand up to the middle of the arm

• A slab equal to the length extending from the middle of the upper arm to the point just proximal to the knuckles in the dorsum of the hand is prepared dry as described in 'Below Elbow Backslab' using a 15 cms PoP roll

• The slab is applied along the posterior aspect of the arm, elbow and the forearm down to the knuckles

• Make slits (about 5 cm) across the slab at the inner and outer aspects of the elbow joint crease. Overlap the cut edges and smooth out the bend without "dog ears"

• To strengthen the slab, at the elbow joint level, another slab of 5 layers is made and applied starting on the medial aspect at the top end of the first slab crossing around the point of the elbow and going upwards on the lateral aspect to the top end
Smoothen the edges (particularly around joints) and place in triangular sling


This type of plaster slab is applied in cases of injuries around the knee and fractures of the tibia and fibula. It extends from the middle of the thigh along the back of the leg and heel to the base of the toes.

• Prepare a dry plaster slab to the above length (8 layers from a 15 cm PoP roll). Prepare two side slabs of length 10 cm shorter than the posterior slab, each with 6 layers. The patient lies on his back. An assistant holds the leg about 25 cm above the couch with one palm under the knee and the other hand holding the toes. The knee is held in 5° flexion and the foot kept at neutral position

 • Cover the patient's knee with a layer of soft cotton roll; apply another pad around the ankle and heel

• Apply a layer of dry gauze bandage firmly from the base of the toes to the middle of the thigh

• Apply the first slab after moistening, starting over the sole of the foot and along the posterior aspect of the leg and thigh and mold it to the leg by rubbing and smoothening it

• Apply the side slabs on the medial and lateral sides of the limb and covering the heel. Mold the slabs over the leg by smoothing the slabs

• Fix the slab with wet gauze bandage, holding the limb in the correct position described above

Rest the leg on two sand bags, one behind the knee and a smaller one behind the ankle

Written by our guest author Pratyush Patowary
Illustrations by Anveshi Nayan

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