SA bandaging

Question 1

EXTERNAL coaptation is defined as the use of?

Answer 1

casts and bandages to help stabilise fractures.

Question 2

What must owners be aware of when using bandages?

Answer 2

Prolonged immobilisation of fractured bones and long-term inactivity may leave the tissues shrivelled, bones thinned, muscles weakened and joints permanently stiff. Following cast removal, animals usually have to undergo prolonged rehabilitation to restore strength and flexibility to tight, weakened muscles and increase the range of motion of stiff joints

Question 3

When is use of external coaptation indicated?

Answer 3

(often due to financial constraints) when limbs need to be cast, so a good understanding of external coaptation will aid in the successful management of these cases.

Question 4

What is the basic priniciple of external coaptation?

Answer 4

The basic principle of external coaptation is to immobilise the joints above and below the fracture. Therefore, fractures distal to the elbow and stifle are most amenable to external coaptation. However, articular fractures and growth plate fractures are exceptions and are best managed with open reduction and internal fixation

Question 5

Trying to immobilise fractures proximal to the elbow and stifle is often difficult, why?

Answer 5

bandage slippage can lead to increased stress on the fracture site.

Question 6

Fractures stabilised using external coaptation have good resistance to?

Answer 6

• Bending and some resistance to rotational forces, but are still subjected to compressive forces acting on them.
• Therefore, transverse fractures are best suited to this type of repair.
• Simple oblique or spiral fractures that are stable following reduction may also occasionally be good candidates (eg, a spiral tibial fracture with an intact fibula or an oblique radial fracture with an intact ulna).

Question 7

What types of fractures are poor candidates for external coaptation?

Answer 7

Unstable spiral and oblique fractures and comminuted fractures are poor candidates for the technique because the fracture forces are not sufficiently neutralised.

Question 8

What are the indications of the use of external coaptation?

Answer 8

■ As a temporary support or first aid before a definitive procedure is performed

■ To reduce postoperative swelling

■ To provide additional support following surgical intervention

■ To help protect wounds

Question 9

Discuss fracture reduction and coaptation?

Answer 9

Minimally displaced fractures are best suited for treatment with external coaptation as reduction does not improve following coaptation.

Question 10

How does breed and age effect healing and the use of external coaptation?

Answer 10

Due to their good healing potential and ability to produce bridging callus within a short period of time, juvenile animals are better suited to external coaptation than adults.

Question 11

With regards to age and breed when should external coaptation be avoided?

Answer 11

Chondrodystrophoid and obese animals are difficult to bandage effectively because of their limb conformation, so alternative methods of fracture management are indicated. Fractures of the distal radius and ulna (particularly in toy breed dogs) have a high incidence of delayed union due to poor blood supply to the area; external coaptation of these fractures should be avoided.

Question 12

How can possible complications be assessed and avoided with external coaptation?

Answer 12

Making sure that the toes are visible at the end of the bandage and checking them on a regular basis is very important. Swelling is usually indicated by the toe nails spreading apart, and if the toes disappear, then the bandage has slipped. A common mistake is to assume that an animal that is chewing its dressing is misbehaving, resulting in a tendency to use an Elizabethan collar or just rewrap the damaged portion rather than spend a little time assessing whether there is a genuine problem.

Question 13

Why do most complications occur with external coaptation?

Answer 13

Most complications are due to poor application (often through poor case selection), poor owner education (see section on client education) or a failure to recognise when a problem is occurring, and the majority of these can be easily avoided.

Question 14

What problems occur with poor application of external coaptation in dogs and cats?

Answer 14

One of the most common problems associated with the use of casts for fractures is non-union due to poor stabilisation:

• The result of inappropriate case selection and can

Other problems associated with poor application are the use of too much or not enough padding, leading to excessive movement or, conversely, too much pressure.

The end result in both cases is rub sores, swelling and vascular compromise, which can cause severe limb injury, ranging from superficial sores to full-thickness loss of skin over the area.

Question 15

How should a cast be applied?

Answer 15

Question 16

When should a cast be applied?

Answer 16

A cast should not be applied to a fracture until all the swelling has subsided; in such cases, a Robert–Jones bandage can be used to provide temporary support.

Question 17

Casts can be described as either:

Answer 17

FULL LEG, extending from the toes to the mid-humerus or mid-femur;

HALF LEG, extending from the toes to just below the elbow or stifle

Question 18

What materials should be used to make a cast?

Answer 18

Synthetic casting tapes made of polyurethane resin-impregnated glass fibre (Vetcast plus; 3M) should be used.

Question 19

What are the benefits of resin impregnanted glass fibre?

Answer 19

several advantages in that the resultant casts are:

• lightweight
• extremely strong
• resistant to impact
• radiolucent
• do not lose strength when wet.

Question 20

How should future cast changes be performed?

Answer 20

■ Cutting the tape and removing the half-shells;

■ Repadding the limb, taking care to ensure the same amount of padding is used, to prevent undue pressure or looseness;

■ Reapplying the half-shells and securing with tape. Labelling the top and bottom of the cast is useful because, once removed, it can sometimes prove difficult to remember the original orientation

Question 21

Dealing with prominent bits of anatomy (eg, the accessory carpal bone) can be tricky when applying casts as there is always the concern that pressure sores may develop. Two techniques can be employed to avoid this, and these involve the use of:

Answer 21

• ‘Doughnuts’ made by cutting holes in small pads (eg, Allevyn; Smith & Nephew);
• Cast padding around but not over the prominent points, to bring everything to the same level and therefore remove pressure

Question 22

What should happen after cast has been applied?

Answer 22

When a cast has been applied, radiographs should be taken to ensure that the fracture has been satisfactorily reduced. It is also advisable to check all casts 24 hours following application to determine how comfortable they are and whether the digits are swollen.

Question 23

When should you change a cast, bandage, or splint?

Answer 23

Cast or splint

• FRACTURE SUPPORT. Check weekly. Change padding and inspect limb every two weeks
• POSTSURGICAL SUPPORT. Change padding and inspect weekly

Robert–Jones bandage

• FRACTURE SUPPORT. Change every two to three days
• GENERAL LIMB SUPPORT. Change weekly

Question 24

What is a robert jones bandage?

Answer 24

The Robert–Jones bandage (and its modifications) provides excellent temporary support for an injured limb. It should extend from the toes to the mid-humerus or mid-femur.

Question 25

How is a robert jones bandage applied?

Answer 25

■ 1 Cover any wounds with an appropriate dressing;

■ 2 Apply tape stirrups (adhesive tape [eg, Elastoplast; 3M Animal Care] is ideal) to the cranial and caudal or medial and lateral surface of the leg. They should extend from above the carpus/tarsus to beyond the toes;

■3 Prepare a cotton wool roll. Unrolling the cotton wool completely and rerolling it in the opposite direction makes it easier to handle. The roll can then be shortened to the required length, thus avoiding overlapping layers and providing better conformation of the bandage to the limb;

■ 4 Starting at the toes, wrap the cotton wool around the limb to the level of the mid-humerus or mid-femur. Overlap the cotton wool by about 50 per cent on itself. The nails of the two middle toes should be visible;

■5 Wrap a conforming gauze over the cotton wool, beginning at the toes and working proximally with strong, even pressure to compress the cotton;

■ 6 Repeat steps 4 and 5 twice, using more pressure each time to compress the cotton wool. The result is a threelayer cotton wool bandage. At the proximal and distal ends of the bandage, the gauze is used to contain the cotton wool and prevent fraying;

■7 Invert the tape stirrups and adhere them to the outer surface of the gauze. If the bandage is sufficiently compressed, it should sound make a hollow echo sound when flicked, like a ‘ripe watermelon’;

■8 Apply a final layer of either adhesive tape or cohesive bandage (eg, Vetrap; 3M Animal Care) if required. A modified Robert–Jones bandage is applied in exactly the same way as a conventional Robert– Jones bandage, but the cotton wool roll is replaced with a light cast padding (eg, Orthoband; Millpledge). This type of dressing will not provide the support necessary to immobilise fractures but can be used following internal fixation to reduce the swelling of soft tissues.

Question 26

It is important that the cast/bandage is looked after properly to avoid potentially serious complications, including pressure sores, swelling and restriction of the blood supply to the limb. Owners should follow these recommendations?

Answer 26

The cast/bandage must be checked twice daily for signs of swelling and other problems.

• ■ Check the toes carefully – gently squeeze the visible toes to ensure they are not swollen or painful.
• ■ Check the pads and nails to ensure they are of normal colour.
• ■ Check the top of the dressing by gently running a finger inside the top of the cast to identify signs of pain/swelling.
• ■ Check the skin above the cast/bandage for increased redness, sores or swelling.
• ■ Check the cast/bandage for a bad smell.

The cast/bandage MUST remain DRY.

• ■ Any water/urine that soaks into the cast/bandage will dry on the outside but may remain soggy and wet underneath next to the skin, resulting in problems related to pressure sores or skin irritation/sloughing.
• ■ Ensure your dog has a strong plastic bag taped firmly to the bandage when going outside. The plastic bag must only be used when the dog is outdoors. If it is left on all the time, it will cause too much sweating and skin problems.
• ■ Use a water bowl that cannot easily be turned over and keep it out of the way to prevent your dog from walking into it. Your dog should walk using the affected leg while it is in the cast/bandage.
• ■ If you notice increasing lameness, this could be a sign that there is a problem

Question 27

When are splints appropriate?

Answer 27

Splints are only suitable for immobilisation of distal limb injuries and should not be used to stabilise more proximal fractures of the radius and tibia.

Question 28

How are splints positioned?

Answer 28

Placement of a splint is very similar to that of a cast. As with casts, less padding (typically two layers of light cast padding [eg, Orthoband]) is used to reduce any motion between the splint and the skin. The splint is positioned over the secondary layer and held in place with an additional layer of gauze. A final layer of either adhesive tape or cohesive bandage can then be applied.

Question 29

What are the key points in SA bandaging management?

Answer 29

■ Robert–Jones bandages and casts are only useful when applied to injuries below the elbow or stifle joint

■ Comminuted fractures and unstable oblique and spiral fractures are not suitable for casting

■ Tape stirrups can help prevent bandage slippage

■ The Robert–Jones bandage is designed to immobilise the limb whereas the modified Robert–Jones bandage provides only partial immobilisation

■ Avoid casting radius/ulna fractures in toy breed dogs

■ Less padding is used under casts and splints to minimise motion

■ Educate clients in the correct management

■ Check bandages/casts on a regular basis

■ Joint laxity is a complication of casting in rapidly growing young dogs. Further coaptation is not appropriate and most cases resolve spontaneously

Question 30

Read the article this info came from here:

Answer 30

https://moodle.nottingham.ac.uk/pluginfile.php/4505458/mod_resource/content/3/4.2.2.11%20First%20Aid%20-%20External%20Coaptation%20SA.pdf