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Slings, Casts, and Other Forms of Immobilization image



AUTHOR: PETER. MOAK




SYNONYM


External coaptation



OVERVIEW AND GOAL


To provide appropriate temporary support and allow healing of musculoskeletal injuries, either alone or as augmentation of surgical repairs



INDICATIONS



• Robert Jones bandage: temporary immobilization of unstable fractures; control of edema and swelling. Appropriate for open fractures following wound dressing.

• Splints: temporary immobilization of fractures or peripheral joint luxations; also used following surgery for joint injuries, arthrodeses, or tendon injuries

• Casts: immobilization of distal limb fractures when mechanically stable; also appropriate following surgical repair—similar to splints

• Slings: partial immobilization of all joints of the limb and prevention of weight bearing. Ehmer sling is used primarily following reduction of hip luxation to prevent recurrence.


CONTRAINDICATIONS


Excessive duration of immobilization may lead to muscle and joint contracture and permanent loss of mobility. Use with caution, especially in pediatric animals.



EQUIPMENT, ANESTHESIA


Sedation may be required for appropriate placement of splints and bandages if animal is in pain or uncooperative. General anesthesia is required for reduction of fractures or joint luxations prior to immobilization. Materials required (amounts and material widths depend on animal size):


• Appropriate wound dressing, if needed

• A 0.5- or 1-inch (1.25 2.5-cm) wide roll of tape

• Rolls of cast padding, 2-6 inches (5-15 cm) width

• Rolls of conforming gauze, 2-6 inches (5-15 cm) width

• Rolls of self-adherent stretch tape

Additional materials:


• Roll of cotton, 12-inch (30-cm) width (for Robert Jones bandage)

• Fiberglass resin or plaster-impregnated casting tape, 2-4 inches (5-10 cm) in width for casts

• Stretch stockinette (for casts, optional)

• Rigid Mason metasplint, lateral plastic limb splint, fiberglass or thermoplastic splint (for splints)


ANTICIPATED TIME


About 10-30 minutes for application of most casts, splints, and slings



PREPARATION: IMPORTANT CHECKPOINTS


Wounds should be treated and an appropriate dressing applied before splinting or bandaging.



POSSIBLE COMPLICATIONS AND COMMON ERRORS TO AVOID



• Toes of the third and fourth digits should be left visible whenever possible to allow monitoring for coolness, swelling, cyanosis, or discharge, any of which warrants removal of the splint, cast, or bandage for closer evaluation of the soft tissues.

• All bandages, splints, slings, and casts should be checked frequently for limb swelling or discoloration, skin abrasions, loosening or slippage, moisture, or odor.

• Severe ischemia can result from poor application or management.


PROCEDURE


ROBERT JONES BANDAGE:


• Divide bulky roll cotton lengthwise and in thickness; reroll to create several smaller, narrower rolls.

• Apply adhesive tape stirrups directly to the skin of the medial and lateral or cranial and caudal surfaces of the distal limb, extending from the carpus or tarsus distally 4-6 inches (10-15 cm) beyond the toes.


image SLINGS, CASTS, AND OTHER FORMS OF IMMOBILIZATION Robert Jones bandage. A, Adhesive tape stirrups (shown in black) are applied to skin on opposite sides of distal limb. Wound dressing is applied as needed. Roll cotton (or for small patients, cast padding) is wrapped evenly around foot. B, Cotton is continued proximally well above site of injury, with overlap of about 50% at each turn, to create the full length of the bandage. C, Conforming gauze is applied in same manner from distal to proximal but pulled tight at each turn. Cotton should be evenly compressed. D, Tape stirrups are reflected proximally and stuck to bandage. An outer tertiary layer of conforming elastic tape is applied over the cotton. Finished bandage should be firm with even compression over entire surface. Toes must be visible for monitoring.
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Jul 24, 2016 | Posted by in SMALL ANIMAL | Comments Off on S

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