F1 GEN SURG TEACHING Flashcards
What is buddy taping?
In buddy-taping, a digit that requires immobilization (eg, because of an injury or deformity) is attached to an adjacent, unaffected digit, helping to provide alignment as well as support and protection. The unaffected digit provides support during range of motion of the injured digit.
Indications for buddy strapping
Minor finger sprain*
Nondisplaced stable fracture of the proximal or middle phalanx
Proximal interphalangeal (PIP) dislocations (reduced)
- Includes sprains with small avulsion fracture
Contraindications of buddy strapping
Unstable or displaced phalangeal fracture
Dislocations that remain unstable after reduction
Tendon injuries (eg, mallet finger, boutonnière injury)
Open fracture
Complications of buddy strapping
Skin breakdown due to lack of padding between fingers
Vascular compromise, usually due to an overly tight application
Equipment needed for buddy strapping
Cotton or gauze for padding
Adhesive tape 1.25 cm (½ inch)
Additional considerations for buddy strapping
Dislocations should be reduced.
Consider a digital block before splinting if manipulation or reduction is required.
Positioning of patient during buddy strapping
The patient should be positioned so that the operator has appropriate access to the patient’s affected finger.
Steps of buddy strapping
Insert cotton padding or gauze between the fingers being splinted to prevent skin maceration between the fingers. Ensure there are no folds in the gauze between the fingers.
Apply tape around both fingers to bind the injured finger against the uninjured finger.
Use one strip of tape to bind adjacent phalanges proximally between the metacarpophalangeal and proximal interphalangeal (PIP) joints, leaving the interphalangeal joints untaped to allow them to flex and extend.
Use a second piece of tape to bind the 2 digits distally between the PIP and distal interphalangeal (DIP) joints, again leaving the interphalangeal joints untaped to allow motion of those joints.
Check distal sensation and capillary refill.
Aftercare of buddy strapping
Arrange or recommend appropriate follow-up.
Patient should keep the tape and padding dry to avoid skin breakdown and change the dressing if it becomes wet.
Instruct the patient to seek further care if pain cannot be controlled with oral medications at home.
Warnings and Common Errors with buddy strapping
Taping too tightly can restrict circulation.
To prevent chronic deformity and loss of function, use buddy-taping only in select finger injuries.
Tips and tricks for buddy strapping
Instruct the patient as you apply the tape, taking care to keep the joints free, so that the patient can reapply the tape should that be necessary.
Additional things to consider during buddy tapping
Additional Considerations
Dislocations should be reduced.
Consider a digital block before splinting if manipulation or reduction is required.
Displaced vs non displaced fractures
Non-displaced fractures differ from displaced fractures in that they do not move the broken bone out of alignment. No significant gap between the fractured pieces occurs to warrant surgical alignment
Management of orthopedic injuries
The most important adage to remember for the surgical management in traumatic orthopaedic complaints is ‘Reduce – Hold – Rehabilitate’
What is reduction in orthopedics and it’s principles
Reduction involves restoring the anatomical alignment of a fracture or dislocation of the deformed limb. Reduction allows for:
Tamponade of bleeding at the fracture site
Reduction in the traction on the surrounding soft tissues, in turn reducing swelling*
Reduction in the traction on the traversing nerves, therefore reducing the risk of neuropraxia
Reduction of pressures on traversing blood vessels, restoring any affected blood supply
The main principle in any reduction, regardless of the method employed, is to correct the deforming forces that resulted in the injury.
Fracture reduction is typically performed closed in the Emergency Room. However, some fractures need to be reduced open (by directly visualising the fracture and reducing it with instruments) intra-operatively.
*Excessively swollen soft tissues have higher rates of wound complications and surgery may be delayed to allow this to regress
Maneuver for reduction
The specific manoeuvre used invariably requires two people (one to perform the reduction manoeuvre and one to provide counter-traction), with a third person needed to apply the plaster
What is hold in orthopedics
Hold’ is the generic term used to describe immobilising a fracture.
Common ways to immobilize a fracture
The most common ways to immobilise a fracture are via simple splints or plaster casts.
