Practical Techniques in Injury Management

ACC14138-1 Pr#11 10/26/06 11:49 AM Page 2
C
M
Y
CM
MY
CY CMY
K
Practical Techniques
in Injury Management
C ASTS A N D S P L I N TS
Composite
ACC14138-1 Pr#11 10/26/06 11:49 AM Page 3
C
M
Y
SE PT E M B E R 2 0 0 6
Prepared by the Accident and Medical Practitioners’ Association
and the ACC Provider Development Unit
Endorsed by NZ Orthopaedic Association and the Decade of Bone and Joint
ACC
P O Box 242, Wellington, New Zealand
Phone 0800 222 070 (Provider Helpline)
www.acc.co.nz
Composite
CM
MY
CY CMY
K
Contents
Contents ............................................................................................................................................................ 1
Introduction....................................................................................................................................................... 3
Above Elbow Backslab (Adult)............................................................................................................................ 5
Below Elbow Backslab (Adult) ............................................................................................................................6
Below Elbow Complete Cast (Adult) .................................................................................................................... 7
Above Elbow Complete Cast (Adult)....................................................................................................................8
Below Knee Complete Cast(Adult) ...................................................................................................................... 9
Below Knee Backslab (Adult) ........................................................................................................................... 10
Volar Slab (Position of Function Splint)..............................................................................................................11
Scaphoid Cast ................................................................................................................................................. 12
Bennett’s Cast ..................................................................................................................................................13
Cast Check ....................................................................................................................................................... 14
Buddy Strapping – Fingers and Toes..................................................................................................................15
Mallet or Stax Splint – Finger............................................................................................................................ 16
Splint – Knee ....................................................................................................................................................17
Velcro Brace – Wrist ......................................................................................................................................... 18
Spica Strapping – Thumb ................................................................................................................................. 19
Taping – Knee .................................................................................................................................................. 20
Taping – Ankle ................................................................................................................................................. 21
Sling – High Arm .............................................................................................................................................. 22
Sling – Broad Arm ............................................................................................................................................ 23
Sling – Collar and Cuff ..................................................................................................................................... 24
Compression Bandaging – Wrist, Ankle, and Knee............................................................................................ 25
R.I.C.E. – Rest, Ice, Compression, Elevation ...................................................................................................... 26
1
ACC14138-2 Pr#11.indd 1
10/26/06 11:50:34 AM
2
ACC14138-2 Pr#11.indd 2
10/26/06 11:50:35 AM
Introduction
Although the treatment of sprains and strains is common in primary care, treatment providers can
often be unaware of tips and techniques that help optimise recovery. Fractures are less frequently
encountered, and yet the application of a plaster cast can be quite difficult. Skills can be easily lost
through lack of day-to-day practice.
This publication and the accompanying DVDs aim to provide a ready reference with easy to follow
instructions on the application of a range of plaster casts and the management of soft tissue injuries.
We hope this will be a useful resource for you in your practice. Some may find it contains new
techniques that are useful, while for others it will serve as a reminder of some of the finer points in injury
management.
The material has been prepared by experienced practitioners and has been through a rigorous validation
process with comments from specialists, GPs, and nurses.
Pages are laminated so the book can be left in the procedure room and wiped down if plaster sprays
onto the pages.
By providing guidance on these practical techniques for treating common injuries our hope is that this
will assist you in fostering an early return to work or independence for injured New Zealanders.
I trust it will be a useful addition to your knowledge base.
Gerard McGreevy
Chief Operating Officer
Accident Compensation Corporation
3
ACC14138-2 Pr#11.indd 3
10/26/06 11:50:35 AM
4
ACC14138-2 Pr#11.indd 4
10/26/06 11:50:35 AM
Above Elbow Backslab (Adult)
Indications
• Acute distal radius and ulna fractures greater than 2.5cm from epiphysis of
the radius
• Clinical fractures of elbow, hand, wrist or forearm
• Forearm and elbow fractures
• Refer to Treatment Profiles for relevant diagnostic tests.
fig 1
Function
Key Points
• Immobilise elbow and wrist
allowing full movement of fingers.
• Refer to Treatment Profiles for time
off work guidelines
• Often used when transporting
to secondary site for definitive
treatment and/or diagnosis.
Position
Materials
• Wrist in neutral, limb held by
assistant with elbow at 90°
• Proximal limit – axilla, leaving
shoulder free
• Distal limit – proximal palmar
crease.
• Double thickness 15 – 20cm slab
POP
• 2 x 10cm slab for struts (Fig 3).
fig 2
Application
• Apply double layer cast padding from proximal palmar crease to axilla,
ensuring no edges in elbow crease (Fig 1)
• Measure slab from palmar crease to 2cm distal to axilla
• Wet slab; apply from palmar crease to axilla covering 50% of dorsal and
ventral surfaces of wrist, forearm and upper arm along ulnar border of limb
(Fig 2)
• Wet 10cm slabs; apply struts to elbows as shown in diagram (Fig 3)
• Turn back padding
• Apply bandage firmly (Fig 4)
• Put arm in broad arm sling for forearm fractures or a collar and cuff (Fig 5) for
elbow injuries.
fig 3
fig 4
Post Application Follow-up
• Cast care instructions given in multiple languages
• Cast check 24 hours
• Removal of cast dependent on injury and age of patient.
fig 5
fig 6
5
ACC14138-2 Pr#11.indd 5
10/26/06 11:50:35 AM
Below Elbow Backslab (Adult)
Indications
• Acute distal radius and ulna fractures less than 2.5 cm from epiphysis of the
radius
• Severe soft tissue injuries of wrist or forearm
• Clinical factures of wrist or forearm
• Refer to Treatment Profiles for relevant diagnostic tests.
fig 1
fig 2
Function
Key Points
• To provide immobilisation allowing
movement of fingers and elbow
and to allow rotation of forearm.
• Refer to Treatment Profiles for time
off work guidelines
• Often used when transporting to
secondary site for definitive
treatment and or diagnosis.
Position
Materials
• Wrist in neutral (Fig 3)
• Proximal limit – 4cm distal to
elbow crease
• Distal limit – proximal palmar
crease.
•
•
•
•
Stockinet
Cast padding
POP slab double thickness
Bandage and sling.
Application
fig 3
fig 4
Below elbow cast incorrect
• Apply stockinet to forearm
• Cut hole for thumb
• Apply single layer of padding from proximal palmar crease to 4cm distal to
elbow crease with double layer over bony prominences
• Cut slab to shape (Fig 1)
• Check slab length on arm extending from proximal palmar crease to 4cm
from elbow crease
• Dip slab in water holding both ends and squeeze gently maintaining shape
• Lay on dorsal aspect of forearm ensuring MCP joints are visible and there is
a gap along ventral surface (Fig 2)
• Turn back stockinet (Fig 3)
• Apply wet bandage (Fig 4)
• Apply sling.
Post Application Follow-up
• Cast care instructions given in multiple languages
• Cast check 24 hours
• Complete cast in one week if required.
fig 2
• POP too distal to palmar crease
• POP not close enough to elbow
• Pressure crease at wrist.
6
ACC14138-2 Pr#11.indd 6
10/26/06 11:50:38 AM
Below Elbow Complete Cast (Adult)
Indications
• Non-acute distal radius and ulna fractures less than 2.5cm proximal to the
distal radial epiphysis
• Refer to Treatment Profiles for relevant diagnostic tests.
Contra-indications
• Acute injuries or gross swelling.
fig 1
Function
Key Points
• Immobilise wrist
• Allow full movement of MCPs and
elbow.
• Refer to Treatment Profiles for time
off work guidelines.
Position
Materials
• Wrist in neutral
• Proximal limit – 4cm distal to
elbow crease
• Distal limit – proximal palmar
crease.
•
•
•
•
Stockinet
Cast padding
10cm slabs for reinforcing
1 – 2 rolls of 7.5cm POP.
fig 2
Application
• Apply stockinet to forearm
• Cut hole for thumb
• Apply single layer of padding from palmar crease to 4cm distal to elbow
crease with double layer over bony prominences
• Cut double layer POP slab to reinforce the ulnar border and a hand piece
split for thumb web space (Fig 1)
• Apply wet POP slabs as shown (Fig 2)
• Turn over edges of stockinette/padding
• Complete cast with roll of POP
• Mould well while POP setting (Fig 3)
• Leave cast with smooth finish (Fig 4)
• Apply sling.
fig 3
fig 4
Post Application Follow-up
• Cast care instructions given in multiple languages
• Cast check 24 hours
• Removal of cast dependent on injury and age of patient.
7
ACC14138-2 Pr#11.indd 7
10/26/06 11:50:40 AM
Above Elbow Complete Cast (Adult)
Indications
• Post-acute radius and ulna fractures more than 2.5cm proximal to distal
radial epiphysis
• Non-acute forearm and elbow fractures
• Refer to Treatment Profiles for relevant diagnostic tests.
Contra-indications
fig 1
• Acute fractures
• Swelling of wrist, forearm or elbow.
Function
Key Points
• Provides immobilisation of elbow
and wrist while allowing full
movement of fingers
• Prevents rotation of forearm.
• Refer to Treatment Profiles for time
off work guidelines.
Position
Materials
• Forearm in neutral/pronation/
supination
• Limb held by assistant
• Elbow at 90°
• Proximal limit – axilla, leaving
shoulder free
• Distal limit – proximal palmar
crease.
•
•
•
•
fig 2
fig 3
Stockinet
Cast padding
POP slabs as shown
2-3 rolls 7.5-10cm POP.
Application
fig 4
fig 5
• Cut POP as indicated (Fig 1)
• Assistant to hold fingers as shown (Fig 2)
• Apply stockinet to arm, adjusting around elbow to prevent creases. Cut hole
for thumb
• Apply single layer of cast padding from palmar crease to 2cm distal to axilla,
ensuring no edges in elbow crease by applying in figure of 8 around elbow
(Fig 3)
• Wet and apply reinforcing slabs (Fig 4)
• Wet and apply 1 POP roll from palmar crease to 2cm distal to axilla
• Turn over edges of stockinet
• Complete cast by applying last rolls of POP (wet) and smooth cast surface
(Fig 5)
• Mould well at wrist and elbow to ensure snug fit
• Broad arm sling.
Post Application Follow-up
• Cast care instructions given in multiple languages
• Cast check 24 hours
• Follow-up dependent on injury.
8
ACC14138-2 Pr#11.indd 8
10/26/06 11:50:42 AM
Below Knee Complete Cast(Adult)
Indications
• Post-acute fractures of ankle and foot
• Refer to Treatment Profiles for relevant diagnostic tests.
Contra-indications
• Swelling of ankle and foot
• Acute injury (use below knee back slab).
90o
fig 1
Function
Key Points
• To immobilise ankle and foot while
allowing movement of toes and
knee joint.
• Refer to Treatment Profiles for time
off work guidelines.
• Avoid common peroneal nerve
behind fibular neck.
Position
Materials
• Ankle at 90°
• Proximal limit – tibial tuberosity,
and 1cm below (distal to) fibular
head to avoid damage to common
peroneal nerve
• Distal limit – web of toes.
•
•
•
•
•
•
Wedge
Assistant
Stockinet
Cast padding
15cm POP slab
2 x 15cm POP rolls.
fig 2
Application
• Patient supine, quadriceps relaxed
• Wedge under knee, assistant holding toes (Fig 1). Try to keep knee bent to
relax gastrocnemius
• Apply stockinet
• Apply cast padding distal to tibial tuberosity down to web of toes, double
layer over bony prominences. Do not overpad ensuring snug fit
• Wet and apply 1 x 15cm POP roll distal to tibial tuberosity to toes (Fig 2)
• Measure and apply wet slab posteriorly, moulding well around ankle (Fig 3)
• Turn back padding
• Apply 2nd POP roll (Fig 4)
• Mould well, leaving cast with smooth finish.
fig 3
fig 4
Post Application Follow-up
•
•
•
•
•
•
Cast care instructions given in multiple languages
Emphasise to the patient that they must not weight-bear
Crutches should be used until further instructed, or until rocker is added
Crutches demonstration and instructions
Cast check 24 hours
Follow up dependent on injury.
9
ACC14138-2 Pr#11.indd 9
10/26/06 11:50:44 AM
Below Knee Backslab (Adult)
Indications
•
•
•
•
Acute fractures of tarsals / metatarsals
Acute fractures of distal tibia/fibula
Severe soft tissue injuries of foot, ankle or lower leg
Refer to Treatment Profiles for relevant diagnostic tests.
Function
Key Points
• Ankle immobilisation for acute
lower leg, ankle or foot injuries.
• Refer to Treatment Profiles for time
off work guidelines
• Often used when transporting
to secondary site for definitive
treatment and/or diagnosis
• Avoid common peroneal nerve.
Position
Materials
• Ankle at 90°
• Proximal limit – tibial tuberosity,
and 1cm below (distal to) fibular
head to avoid damage to common
peroneal nerve
• Distal limit – web of toes.
•
•
•
•
•
•
fig 1
fig 2
Wedge
Assistant
Cast padding
15cm crepe bandage
15-20cm POP slab double thickness
10cm POP slab for ankle struts.
Application
•
•
•
•
•
fig 3
•
•
•
•
•
•
fig 4
Patient supine, quadriceps relaxed
Must keep knee bent to relax gastrocnemius
Wedge under knee, assistant holding toes (Fig 1)
Apply double layer of cast padding, extra around malleoli and shin
Pre-measure slab to fit from tibial tuberosity and distal to fibular head down
to web of toes
Wet and apply double thickness slab (Fig 2)
Measure 10cm slab down each side of leg and under foot
Wet and apply as shown (Fig 3) and (Fig 4)
Turn back padding
Apply crepe bandage (Fig 5)
Ensure patient can fully extend and flex knee and toes.
Post Application Follow-up
•
•
•
•
•
fig 5
Below knee cast incorrect
Cast care instructions given in multiple languages
Emphasis to patient that they must not weight-bear
Crutches should be used until further instructed or until rocker is added
Cast check 24 hours
Removal of cast, dependent on injury and age of patient.
Below knee cast incorrect
• POP proximal to tibial tuberosity
• Ankle inverted and plantarflexed
• POP too distal covering little
toes
fig 4 • POP wrinkled at ankle.
10
ACC14138-2 Pr#11.indd 10
10/26/06 11:50:46 AM
Volar Slab (Position of Function Splint)
Indications
•
•
•
•
Finger and hand fractures
Finger, hand, tendon and ligament injuries
Severe soft tissue injuries of the hand
Refer to Treatment Profiles for relevant diagnostic tests.
Function
Key Points
• Provides immobilisation in
position of function of wrist, hand
and fingers.
• All fingertips must be visible
to allow easy assessment of
circulation
• Refer to Treatment Profiles for time
off work guidelines
• Discussion or referral to Specialist
is recommended for all hand and
finger fractures.
fig 1
fig 2
Position
Materials
•
•
•
•
•
•
•
•
Wrist 45° dorsiflexion
MCP joints 90°
Fingers fully extended
Proximal limit – 4cm distal to
elbow crease
• Distal limit – to finger tips.
Stockinet
Cast Padding
10cm POP slab
Bandage.
fig 3
Application
• Apply stockinet covering all of hand and ensuring it extends far enough past
fingertips to allow turnover (Fig 2). Cut hole for thumb
• Apply single layer cast padding (extra over bony prominences)
• Measure double thickness POP slab to extend from fingertips to 4cm distal
to elbow crease. Trim to fit neatly around thumb
• Wet slab and apply to hand and forearm (Fig 3)
• Turn stockinet edges down ensuring that all fingertips are visible
• Apply bandage and mould to shape (Fig 4 and Fig 5)
• High arm sling.
fig 4
Post Application Follow-up
• Cast check 24 hours
• Clinical review within seven days
• Cast care instructions given in multiple languages.
fig 5
11
ACC14138-2 Pr#11.indd 11
10/26/06 11:50:49 AM
Scaphoid Cast
Indications
fig 1
• Suspected or ‘clinical’ fracture of scaphoid
• Significant delay in Xray or specialist assessment
• If fracture is confirmed or ‘clinical’, then referral to specialist should be
arranged. In this case it may not be necessary to apply a full scaphoid cast
as it will be removed for assessment
• Refer to Treatment Profiles for relevant diagnostic tests
• Many surgeons treat scaphoid fractures which do not require ORIF in BE
complete cast, allowing some thumb function and ability to work.
Function
Key Points
• To hold the thumb in opposition
and immobilise wrist.
• Refer specialist opinion
• Follow up essential
• Refer to Treatment Profiles for time
off work guidelines.
Position
Materials
• Thumb in opposition
• Middle finger and thumb forming
an “O” (Fig 1)
• Wrist in neutral
• Proximal limit – 4cm distal to
elbow crease
• Distal limit – to ip joint of thumb
and proximal palmar crease
•
•
•
•
fig 2
fig 3
Stockinet
Cast Padding
10cm slab as diagram
1-2 rolls 7.5cm POP.
Application
•
•
•
•
fig 4
•
•
•
•
•
•
•
fig 5
Ensure hand in correct position (Fig 1)
Cut POP slabs as shown (Fig 2)
Apply stockinet
Apply layer of padding around thumb to IP joint and wrist and to 4cm distal
to elbow crease (Fig 3)
Apply reinforcing slabs to base of thumb (Fig 4)
Turn back padding
Complete with POP bandage
Cut bandage to ensure snug fit around thumb web (Fig 5)
Mould well while setting (Fig 6)
Ensure full movement of IP joint
Apply sling.
Post Application Follow-up
•
•
•
•
•
Cast care instructions in multiple languages
Cast check 24 hours
Definite – review one week refer specialist
Clinical fracture review – minimum 14 days for re-Xray
If Xray fracture or clinical fracture refer specialist.
fig 6
12
ACC14138-2 Pr#11.indd 12
10/26/06 11:50:52 AM
Bennett’s Cast
Indications
• Fracture to base of thumb metacarpal (Bennett’s fracture)
• See Treatment Profiles for relevant diagnostic tests.
Function
Key Points
• Provides immobilisation of thumb
while allowing full movement of
fingers.
• Tip of thumb must be visible
to allow easy assessment of
circulation
• Refer to Treatment Profiles for time
off work guidelines
• Referral to, or discussion with,
specialist is recommended for all
Bennett’s fractures.
Position
Materials
• Wrist in neutral
• Position with thumb extended
(Fig 1)
• Proximal limit – 4cm distal to
elbow crease
• Distal limit – tip of thumb and
proximal palmar crease.
•
•
•
•
•
fig 1
fig 2
Stockinet
Thumb stockinet
Cast padding
10cm slab for reinforcing (Fig 3)
1-2 rolls 7.5cm POP.
Application
fig 3
• Ensure hand in correct position (Fig 1)
• Apply stockinet to arm, separate piece to thumb (Fig 2)
• Apply single layer of padding from palmar crease to 4cm distal to elbow
crease (Fig 4)
• Wet POP slabs and apply (Fig 5)
• Fold over edges of stockinet
• Wet and apply POP roll ensuring smooth finish (Fig 6)
• Mould well around base of thumb and thenar eminence (Fig 7), keeping
thumb abducted
• Broad arm sling.
fig 4
Post Application Follow-up
• Cast care instructions given in multiple languages
• Cast check 24 hours
• Clinical review within seven days.
fig 5
fig 7
fig 6
13
ACC14138-2 Pr#11.indd 13
10/26/06 11:50:54 AM
Cast Check
Below elbow cast correct
Indications
• Immediately post application
• At one day – 24 hours
• At any time concerns arise.
fig 1
Below elbow cast incorrect
fig 2
Function
Key Points
•
•
•
•
• Application of any cast has the
potential to cause serious harm to
a patient – hence the importance
of a cast check
• Clearly identify proximal and distal
limits of cast
• Refer to Treatment Profiles for
relevant diagnostic tests and time
off work.
To check appropriate choice of cast
To check position
To assess function of the limb
To minimise complications
(iatrogenic or due to the underlying
injury).
Position
Specific Advice
• Appropriate for choice of cast.
• Elevation advice
• Crutches demonstration and
advice
• Weight-bearing restrictions
• Slings
• Patient-driven problem solving.
• POP too distal to palmar crease
• POP not close enough to elbow
• Pressure crease at wrist.
Procedure
Below knee cast correct
fig 3
Below knee cast incorrect
fig 4
Below knee cast incorrect
• POP proximal to tibial tuberosity
Post-application check
• Check that the appropriate cast
has been applied
• Ask the patient about comfort and
fit including
– tingling
– numbness
– pain
• Examine and document
– neurovascular status
– swelling
– distal limb movement/distal
tendon function
Check:
• Pressure points
• Analgesia requirements
• Patient knows follow-up
instructions for next check/change.
Day 1 and subsequent checks
• Check that this is the cast that was
ordered
• Ask the patient about comfort and fit
• Ask the patient about pain
• Examine and document
– neurovascular status
– swelling
– distal limb movement/tendon
function
– condition of cast (any damage?)
Check:
• Pressure points
• Analgesia requirements
• Patient knows follow-up
instructions for next check/change
• Split and remove cast if necessary
for pain and swelling.
• Ankle inverted and plantarflexed
• POP too distal covering little
toes
• POP wrinkled at ankle.
General Follow-up
• Written material: cast care instructions in multiple languages
• As appropriate: appointment – copy of clinical record – Xrays.
14
ACC14138-2 Pr#11.indd 14
10/26/06 11:50:57 AM
Buddy Strapping – Fingers and Toes
Indications
• Joint injuries of fingers
• Some simple fractures of phalanges or metacarpals.
Function
Key Points
• Mobilisation
• Support.
• Tape leaves PIP and DIP joints free
to mobilise.
Position
Materials
• Leaves DIP and PIP joints free.
• 1cm zinc oxide tape
• Gauze padding
• Scissors.
fig 1
Application
•
•
•
•
Pre-cut gauze to fit between toes and fit in place (Fig 4)
Gauze may also be used for fingers
Apply two pieces of tape to hold fingers/toes together (Fig 2 and 5)
Ensure finger joints are mobile.
fig 2
Post Application Follow-up
•
•
•
•
Encourage gentle hand movement and use
Within one week
Replace if loose
Release strapping if swelling increases.
fig 3
fig 4
fig 5
fig 6
15
ACC14138-2 Pr#11.indd 15
10/26/06 11:50:58 AM
Mallet or Stax Splint – Finger
Indications
‘Mallet’ finger injuries including
• Extensor tendon injuries
• Extensor tendon avulsion fractures of base of terminal phalanx.
fig 1
fig 2
Function
Key Points
• Immobilisation (DIP Joints) to allow
healing of fracture/scarring of
extensor apparatus.
• DIP Joint must be neutral or mildly
hyper-extended
• Instruction sheet essential for selfmaintenance
• The key is not to let the DIP flex
even slightly during the period of
immobilisation.
Position
Materials
• DIP Joint hyperextended (Fig 2) or
neutral
• Ensure the plastic splint is not
loose fitting (results in extension
lag).
•
•
•
•
1cm zinc oxide tape
2cm elastoplast tape
Splints (various sizes)
Scissors.
Application
fig 3
• Add tubinette and talcum, then apply 1cm tape to finger in ‘figure of 8’
position (Fig 3) (maintain) (see Note below)
• Maintain full extension at DIP joint
• Avoid hyper-extension as this is painful and skin can necrose
• Apply splint (Fig 4)
• Tape splint in place (Fig 5).
Note: Some practitioners apply the splint without the initial ‘figure of 8’ tape.
Post Application Follow-up
fig 4
•
•
•
•
Instructions sheet for self maintenance
Review if splint is lost or loose
Relevant to injury
Splint needs to be cleaned daily
– maintain extension
– Slide splint off, wash and talcum powder
• Splint must stay for 6 weeks.
fig 5
16
ACC14138-2 Pr#11.indd 16
10/26/06 11:51:00 AM
Splint – Knee
Indications
Acute knee injuries including
• Contusions/sprains
• Patella fractures
• Ligamentous tears.
Function
Key Points
• Immobilisation
• Support.
• Partially immobilises knee joint
• Temporary splint only
• Early referral if diagnosis/
management unclear.
Position
Materials
• Knee extended.
• Knee splint
• Crutches
• +/- Tubigrip.
fig 1
fig 2
Application
•
•
•
•
•
•
Patient’s leg horizontal (Fig 2)
Patella sits in ‘keyhole’ (Fig 3)
Velcro strap firmly tightened (Fig 3)
Crutches for walking (Fig 4)
Encourage partial weight bearing
Tubigrip over skin if swelling present.
fig 3
Post Application Follow-up
• Two to three days for reassessment
• Must take some weight with crutches
• Concentrate on isometric static quadriceps exercises and lifting leg if
possible.
fig 4
17
ACC14138-2 Pr#11.indd 17
10/26/06 11:51:01 AM
Velcro Brace – Wrist
Indications
Wrist injuries including
• Sprains
• Tenosynovitis
• Contusions to wrist.
Function
Key Points
• Immobilisation
• Support.
• Immobilises wrist
• Temporary splint only
• Early referral if diagnosis/
management is unclear.
Position
Materials
• Position of ‘function’ of wrist and
hand.
• Velcro wrist splint.
fig 1
fig 2
Application
• Establish most appropriate size of splint ( Fig 2)
• Fit firmly to wrist
• Mould in ‘position of function’ (Fig 3 and Fig 4).
Post Application Follow-up
fig 3
• Patient advice about removal
• Follow-up depending on injury.
fig 4
18
ACC14138-2 Pr#11.indd 18
10/26/06 11:51:02 AM
Spica Strapping – Thumb
Indications
• Injuries to MCP joint at thumb: eg UCL.
Function
Key Points
• Partial Immobilisation
• Support.
• Prevents radial deviation at MCP
Joint
• Allows movement at IP Joint and
wrist
• Temporary splint only
• Early referral if diagnosis/
management is unclear.
Position
Materials
• Thumb in neutral.
• 2cm elastoplast tape
• Scissors.
fig 1
fig 2
Application
• Apply in figure 8 method (Fig 3) starting distally and overlapping by moving
proximally down thumb (Fig 4)
• Apply final strip in figure 8 then secure around wrist (Fig 5 and Fig 6).
Post Application Follow-up
• Review at one to two weeks and then at two to four weeks depending on
injury.
fig 3
fig 4
fig 5
fig 6
19
ACC14138-2 Pr#11.indd 19
10/26/06 11:51:03 AM
Taping – Knee
Indications
• Medial collateral tears of knee.
fig 1
Function
Key Points
• Immobilisation (partial)
• Proprioception
• Support.
• Shaved skin best
• Check for contact allergy
• Tubigrip over strapping if swelling.
Position
Materials
• Standing
• 10 – 20˚ leg flexion (Fig 2).
• Leuko 3cm tape
• Scissors.
Application
fig 2
• Standing
• Apply anchor tape one-hand width above and below knee (Fig 3)
• Apply cross straps from top anchor to bottom anchor on medial side of knee
(Fig 4)
• Apply successive cross strap layers (Fig 5)
• Lock anchor straps top and bottom (Fig 6).
Post Application Follow-up
fig 3
• Two to four days for review
• Self-removal if irritation present
• Emphasise isometric static quadriceps exercises.
fig 4
fig 5
fig 6
20
ACC14138-2 Pr#11.indd 20
10/26/06 11:51:05 AM
Taping – Ankle
Indications
• Tears of ankle ligaments.
Function
Key Points
• Immobilisation (partial)
• Proprioception
• Support.
• Ankle in neutral
• Tape follows skin and joint
contours
• Check for contact allergy.
Position
Materials
• Ankle in neutral (Fig 2) – (foot at
90° to lower leg).
• Leuko 3cm tape
• Scissors.
fig 1
Application
•
•
•
•
Apply anchor tape one-hand space above ankle (Fig 3)
Apply 2 – 3 stirrups (Fig 4)
Stirrup applied from medial side of leg around arch of foot to lateral side
Locking tape applied last (Fig 5).
fig 2
Post Application Follow-up
• Three to four days for check and /or replacement
• Self-removal if irritation present.
fig 3
fig 4
fig 5
21
ACC14138-2 Pr#11.indd 21
10/26/06 11:51:06 AM
Sling – High Arm
Indications
fig 1
fig 2
Injuries to hand, fingers and wrist
To elevate an injured area above the heart, including:
• Significant wounds
• Fractures
• Dislocations
• Tendon injuries
• Soft tissue injuries.
Function
Key Points
• Immobilisation
• Elevation
• Support.
• High arm sling provides better
hand elevation than broad arm
sling.
Position
Materials
• Injured limb’s hand on opposite
shoulder.
• Sling
• Scissors.
Application
fig 3
•
•
•
•
Sling over injured arm (Fig 1)
‘Point’ of sling position at elbow (Fig 1 and Fig 2)
Lower point rolled under arm (Fig 2) and tied behind neck (Fig 3)
Pinned at elbow (Fig 3).
Post Application Follow-up
• Advice about showering/night-time removal
• Relevant to specific injury.
22
ACC14138-2 Pr#11.indd 22
10/26/06 11:51:07 AM
Sling – Broad Arm
Indications
• Forearm fractures
• Casts – including below elbow casts
• Some shoulder injuries
– fractured clavicles
– a-c joints
• Elbow injuries.
fig 1
Function
Key Points
• Immobilisation
• Elevation
• Support.
• Broad arm sling does not provide
as much hand elevation as a high
arm sling and so is less suited to
finger and hand injuries.
Position
Materials
• Elbow at 90° flexion.
• Sling
• Scissors.
fig 2
Application
•
•
•
•
•
Position sling under injured arm
‘Point’ of sling positioned at elbow (Fig 1)
Lift lower point and tie behind neck (Fig 2)
Pin the elbow (Fig 3)
Avoid pressure over the AC joint.
fig 3
Post Application Follow-up
• Advice about showering/night-time removal
• Relevant to specific injury.
23
ACC14138-2 Pr#11.indd 23
10/26/06 11:51:08 AM
Sling – Collar and Cuff
Indications
• Hanging casts
• Humerus fractures – proximal or shaft.
fig 1
fig 2
Function
Key Points
• Immobilisation
• Elevation
• Support.
• A broadarm sling may be more
comfortable for elbow and forearm
injuries
• Supporting the weight of the
arm is important after shoulder
dislocation as the injured tissue
needs to tighten with the joint
supported, therefore use a sling.
Position
Materials
• Elbow at 90° flexion
• Greater flexion may be required for
some elbow injuries.
• Collar and cuff material
• Scissors.
Application
•
•
•
•
•
Collar and cuff around neck (Fig 1)
One end lower than the other (Fig 1)
Fold lower end up and pin to upper end (Fig 2)
In children, pin tightly enough to gently trap wrist
Can be worn under clothes.
Post Application Follow-up
• Advice about showering/night-time removal
• Relevant to specific injury.
24
ACC14138-2 Pr#11.indd 24
10/26/06 11:51:09 AM
Compression Bandaging – Wrist, Ankle, and Knee
Indications
• Any soft tissue injury where swelling is occurring
• Used to mobilise limb injuries unless used in conjunction with a rigid splint.
Function
Key Points
• Limited mobilisation
• Support.
• Mould to limb contours
• Double over for extra compression
• Use applicator for reduced pain to
patient
• Do not twist or spiral.
Position
Materials
• Hand and forearm – leave MCP
joints free to move
• Lower leg – leave MTP joint free to
move
• Knee – leave knee joint free to
move.
•
•
•
•
Tubigrip (various sizes)
Use sizing tape
Applicator (various sizes)
Scissors.
fig 1
fig 2
Application
Wrist and Hand:
• Cut thumb hole (Fig 2)
• Leave MCP joints free to move and for swelling/circulatory assessment.
Ankle:
• Leave MTP joints and toes free.
fig 3
Knee:
• Extends two-hand breadths above and below the knee joint.
Post Application Follow-up
• Advice about washing/removal at night.
fig 4
fig 5
fig 6
25
ACC14138-2 Pr#11.indd 25
10/26/06 11:51:09 AM
R.I.C.E. – Rest, Ice, Compression, Elevation
Indications
• Acute soft tissue injuries with actual or potential swelling.
fig 1
fig 2
Function
Key Points
• Minimise swelling by reducing
bleeding
• Reduce pain
• Reduce further injury.
• Elevate affected area above the
level of the heart where possible
• Apply ice during first 48 hours
• Do not apply ice to bare skin
• Caution use with children, elderly
and people with circulatory
problems
• Beware of ice burns which may add
complications if ice left in place for
too long.
Position
Materials
• Limb elevated with injured area
above the level of the heart (Fig 1).
• Ice (Fig 2 and Fig 3)
• Plastic bag
• Cloth wrapping.
Application
fig 3
• Rest – Rest localised injured area
Eg. Upper limb – sling, splint
Lower limb – splints, crutches or cushioned rest
• Ice – 10 minutes every one to two hours for up to 48 hours
• Compression – bandage eg. Tubigrip/padding/crepe
– monitor often and adjust where necessary
• Elevation – during the acute phase of the injury
– whenever possible above level of heart (Fig 1).
Post Application Follow-up
• Encourage ongoing elevation of the injured limb
• Referral when necessary to ascertain the extent of injury to appropriate
health professional. These may include doctor, A & M Clinic,
physiotherapist, nurse, paramedic
• Encourage gentle exercise when comfortable and within limits of pain.
26
ACC14138-2 Pr#11.indd 26
10/26/06 11:51:11 AM
ACC14138-1 Pr#11 10/26/06 11:49 AM Page 4
C
Composite
M
Y
CM
MY
CY CMY
K
ACC14138-1 Pr#11 10/26/06 11:49 AM Page 1
C
M
Y
CM
MY
CY CMY
K
ISBN 0–478–27971–X • ACC2373
Composite