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Practical Techniques

in Injury ManagementCASTS AND SPLINTS

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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

Bennetts 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

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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 validationprocess 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 OfficerAccident Compensation Corporation

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Above Elbow Backslab (Adult)

fig 1

fig 2

fig 3

fig 4

fig 5

fig 6

fig 1

fig 2

fig 3

fig 4

fig 5

fig 6

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.

Function

Immobilise elbow and wrist

allowing full movement of fingers.

Key Points

Refer to Treatment Profiles for time

off work guidelines

Often used when transporting

to secondary site for definitive

treatment and/or diagnosis.

Position

Wrist in neutral, limb held by

assistant with elbow at 90

Proximal limit axilla, leaving

shoulder free

Distal limit proximal palmar

crease.

Materials

Double thickness 15 20cm slab

POP

2 x 10cm slab for struts (Fig 3).

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.

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.

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Below Elbow Backslab (Adult)

fig 1

fig 2

fig 3

fig 4

fig 1

fig 2

fig 3

fig 4

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


Function

To provide immobilisation allowing

movement of fingers and elbow

and to allow rotation of forearm.

Key Points


off work guidelines

Often used when transporting to

secondary site for definitive

treatment and or diagnosis.

Position

Wrist in neutral (Fig 3)

Proximal limit 4cm distal to

elbow crease


crease.

Materials

Stockinet

Cast padding

POP slab double thickness

Bandage and sling.

Application

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.

POP too distal to palmar crease

POP not close enough to elbow

Pressure crease at wrist.

Below elbow cast incorrect

fig 2

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Indications

Non-acute distal radius and ulna fractures less than 2.5cm proximal to the

distal radial epiphysis


Contra-indications

Acute injuries or gross swelling.

Function

Immobilise wrist

Allow full movement of MCPs and

elbow.

Key Points


off work guidelines.

Position

Wrist in neutral


elbow crease


crease.

Materials

Stockinet

Cast padding

10cm slabs for reinforcing

1 2 rolls of 7.5cm POP.

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 piecesplit 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.


Cast care instructions given in multiple languages

Cast check 24 hours

Removal of cast dependent on injury and age of patient.

Below Elbow Complete Cast (Adult)

fig 1

fig 2

fig 3

fig 4

fig 1

fig 2

fig 3

fig 4

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Above Elbow Complete Cast (Adult)

fig 1

fig 2

fig 3

fig 4

fig 5

fig 1

fig 2

fig 3

fig 4

fig 5

Indications

Post-acute radius and ulna fractures more than 2.5cm proximal to distal

radial epiphysis

Non-acute forearm and elbow fractures


Contra-indications

Acute fractures

Swelling of wrist, forearm or elbow.

Function

Provides immobilisation of elbow

and wrist while allowing full

movement of fingers

Prevents rotation of forearm.

Key Points



Position

Forearm in neutral/pronation/

supination

Limb held by assistant

Elbow at 90

Proximal limit axilla, leaving

shoulder free


crease.

Materials

Stockinet

Cast padding

POP slabs as shown

2-3 rolls 7.5-10cm POP.

Application

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.



Cast check 24 hours

Follow-up dependent on injury.

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Indications

Post-acute fractures of ankle and foot


Contra-indications

Swelling of ankle and foot

Acute injury (use below knee back slab).

Function

To immobilise ankle and foot while

allowing movement of toes and

knee joint.

Key Points



Avoid common peroneal nerve

behind fibular neck.

Position

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.

Materials

Wedge

Assistant

Stockinet

Cast padding

15cm POP slab

2 x 15cm POP rolls.

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.



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.

Below Knee Complete Cast(Adult)

fig 1

fig 2

fig 3

fig 4

fig 1

fig 2

fig 3

fig 4

90o

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Below Knee Backslab (Adult)

fig 1

fig 2

fig 3

fig 4

fig 5

fig 1

fig 2

fig 3

fig 4

fig 5

Indications

Acute fractures of tarsals / metatarsals

Acute fractures of distal tibia/fibula

Severe soft tissue injuries of foot, ankle or lower leg


Function

Ankle immobilisation for acute

lower leg, ankle or foot injuries.

Key Points


off work guidelines

Often used when transporting

to secondary site for definitive

treatment and/or diagnosis

Avoid common peroneal nerve.

Position

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.

Materials

Wedge

Assistant

Cast padding

15cm crepe bandage

15-20cm POP slab double thickness

10cm POP slab for ankle struts.

Application

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 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

POP wrinkled at ankle.


fig 4

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Indications

Finger and hand fractures

Finger, hand, tendon and ligament injuries

Severe soft tissue injuries of the hand


Function

Provides immobilisation in

position of function of wrist, hand

and fingers.

Key Points

All fingertips must be visible

to allow easy assessment of

circulation


off work guidelines

Discussion or referral to Specialist

is recommended for all hand andfinger fractures.

Position

Wrist 45 dorsiflexion

MCP joints 90

Fingers fully extended


elbow crease

Distal limit to finger tips.

Materials

Stockinet

Cast Padding

10cm POP slab

Bandage.

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.


Cast check 24 hours Clinical review within seven days

Cast care instructions given in multiple languages.

Volar Slab (Position of Function Splint)

fig 1

fig 2

fig 3

fig 4

fig 5

fig 1

fig 2

fig 3

fig 4

fig 5

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Indications

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

To hold the thumb in opposition

and immobilise wrist.

Key Points

Refer specialist opinion

Follow up essential

Refer to Treatment Profiles for timeoff work guidelines.

Position

Thumb in opposition

Middle finger and thumb forming

an O (Fig 1)

Wrist in neutral


elbow crease

Distal limit to ip joint of thumb

and proximal palmar crease

Materials

Stockinet

Cast Padding

10cm slab as diagram

1-2 rolls 7.5cm POP.

Application

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.


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.

Scaphoid Cast

fig 1

fig 2

fig 3

fig 4

fig 5

fig 6

fig 1

fig 2

fig 3

fig 4

fig 5

fig 6

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Bennetts Cast

fig 1

fig 2

fig 3

fig 4

fig 5

fig 6

fig 1

fig 2

fig 3

fig 4

fig 5

fig 6

Indications

Fracture to base of thumb metacarpal (Bennetts fracture)

See Treatment Profiles for relevant diagnostic tests.

Function

Provides immobilisation of thumb

while allowing full movement of

fingers.

Key Points

Tip of thumb must be visible

to allow easy assessment of

circulation


off work guidelines

Referral to, or discussion with,

specialist is recommended for all

Bennetts fractures.

Position

Wrist in neutral

Position with thumb extended

(Fig 1)


elbow crease

Distal limit tip of thumb and

proximal palmar crease.

Materials

Stockinet

Thumb stockinet

Cast padding

10cm slab for reinforcing (Fig 3)

1-2 rolls 7.5cm POP.

Application

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.


Cast care instructions given in multiple languages Cast check 24 hours

Clinical review within seven days.

fig 7

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Indications

Immediately post application

At one day 24 hours

At any time concerns arise.

Function

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).

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 timeoff work.

Position

Appropriate for choice of cast.

Specific Advice

Elevation advice

Crutches demonstration and

advice

Weight-bearing restrictions

Slings

Patient-driven problem solving.

Procedure

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.

General Follow-up

Written material: cast care instructions in multiple languages

As appropriate: appointment copy of clinical record Xrays.

Cast Check

Below elbow cast correct

fig 1

POP too distal to palmar crease

POP not close enough to elbow

Pressure crease at wrist.

Below elbow cast incorrect

fig 2

Below knee cast correct

fig 3


POP proximal to tibial tuberosity

Ankle inverted and plantarflexed

POP too distal covering little

toes

POP wrinkled at ankle.


fig 4

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Buddy Strapping Fingers and Toes

fig 1

fig 2

fig 3

fig 4

fig 5

fig 6

fig 1

fig 2

fig 3

fig 4

fig 5

fig 6

Indications

Joint injuries of fingers

Some simple fractures of phalanges or metacarpals.

Function

Mobilisation

Support.

Key Points

Tape leaves PIP and DIP joints free

to mobilise.

Position

Leaves DIP and PIP joints free.

Materials

1cm zinc oxide tape

Gauze padding

Scissors.

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.


Encourage gentle hand movement and use

Within one week

Replace if loose

Release strapping if swelling increases.

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Indications

Mallet finger injuries including

Extensor tendon injuries

Extensor tendon avulsion fractures of base of terminal phalanx.

Function

Immobilisation (DIP Joints) to allow

healing of fracture/scarring of

extensor apparatus.

Key Points

DIP Joint must be neutral or mildly

hyper-extended

Instruction sheet essential for self-

maintenance

The key is not to let the DIP flex

even slightly during the period of

immobilisation.

Position

DIP Joint hyperextended (Fig 2) or

neutral

Ensure the plastic splint is not

loose fitting (results in extension

lag).

Materials

1cm zinc oxide tape

2cm elastoplast tape

Splints (various sizes)

Scissors.

Application

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.


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.

Mallet or Stax Splint Finger

fig 1

fig 2

fig 3

fig 4

fig 5

fig 1

fig 2

fig 3

fig 4

fig 5

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Splint Knee

fig 1

fig 2

fig 3

fig 4

fig 1

fig 2

fig 3

fig 4

Indications

Acute knee injuries including

Contusions/sprains

Patella fractures

Ligamentous tears.

Function

Immobilisation

Support.

Key Points

Partially immobilises knee joint

Temporary splint only

Early referral if diagnosis/

management unclear.

Position

Knee extended.

Materials

Knee splint Crutches

+/- Tubigrip.

Application

Patients 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.


Two to three days for reassessment

Must take some weight with crutches

Concentrate on isometric static quadriceps exercises and lifting leg if

possible.

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Indications

Wrist injuries including

Sprains

Tenosynovitis

Contusions to wrist.

Function

Immobilisation

Support.

Key Points

Immobilises wrist



management is unclear.

Position

Position of function of wrist andhand.

Materials

Velcro wrist splint.

Application

Establish most appropriate size of splint ( Fig 2)

Fit firmly to wrist

Mould in position of function (Fig 3 and Fig 4).


Patient advice about removal

Follow-up depending on injury.

Velcro Brace Wrist

fig 1

fig 2

fig 3

fig 4

fig 1

fig 2

fig 3

fig 4

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Spica Strapping Thumb

fig 1

fig 2

fig 3

fig 4

fig 5

fig 6

fig 1

fig 2

fig 3

fig 4

fig 5

fig 6

Indications

Injuries to MCP joint at thumb: eg UCL.

Function

Partial Immobilisation

Support.

Key Points

Prevents radial deviation at MCP

Joint

Allows movement at IP Joint and

wrist



management is unclear.

Position

Thumb in neutral.

Materials

2cm elastoplast tape Scissors.

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).


Review at one to two weeks and then at two to four weeks depending on

injury.

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Indications

Medial collateral tears of knee.

Function

Immobilisation (partial)

Proprioception

Support.

Key Points

Shaved skin best

Check for contact allergy

Tubigrip over strapping if swelling.

Position

Standing

10 20 leg flexion (Fig 2).

Materials

Leuko 3cm tape

Scissors.

Application

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).


Two to four days for review

Self-removal if irritation present

Emphasise isometric static quadriceps exercises.

Taping Knee

fig 1

fig 2

fig 3

fig 4

fig 5

fig 6

fig 1

fig 2

fig 3

fig 4

fig 5

fig 6

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Taping Ankle

fig 1

fig 2

fig 3

fig 4

fig 5

fig 1

fig 2

fig 3

fig 4

fig 5

Indications

Tears of ankle ligaments.

Function

Immobilisation (partial)

Proprioception

Support.

Key Points

Ankle in neutral

Tape follows skin and joint

contours

Check for contact allergy.

Position

Ankle in neutral (Fig 2) (foot at

90 to lower leg).

Materials

Leuko 3cm tape

Scissors.

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).


Three to four days for check and /or replacement

Self-removal if irritation present.

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Indications

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

Immobilisation

Elevation

Support.

Key Points

High arm sling provides better

hand elevation than broad arm

sling.

Position

Injured limbs hand on opposite

shoulder.

Materials

Sling

Scissors.

Application

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).


Advice about showering/night-time removal

Relevant to specific injury.

Sling High Arm

fig 1

fig 2

fig 3

fig 1

fig 2

fig 3

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Sling Broad Arm

fig 1

fig 2

fig 3

fig 1

fig 2

fig 3

Indications

Forearm fractures

Casts including below elbow casts

Some shoulder injuries

fractured clavicles

a-c joints

Elbow injuries.

Function

Immobilisation

Elevation

Support.

Key Points

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

Elbow at 90 flexion.

Materials

Sling

Scissors.

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.




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Indications

Hanging casts

Humerus fractures proximal or shaft.

Function

Immobilisation

Elevation

Support.

Key Points

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

Elbow at 90 flexion

Greater flexion may be required for

some elbow injuries.

Materials

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.




Sling Collar and Cuff

fig 1

fig 2

fig 1

fig 2

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Compression Bandaging Wrist, Ankle, and Knee

fig 1

fig 2

fig 3

fig 4

fig 5

fig 6

fig 1

fig 2

fig 3

fig 4

fig 5

fig 6

Indications

Any soft tissue injury where swelling is occurring

Used to mobilise limb injuries unless used in conjunction with a rigid splint.

Function

Limited mobilisation

Support.

Key Points

Mould to limb contours

Double over for extra compression

Use applicator for reduced pain to

patient

Do not twist or spiral.

Position

Hand and forearm leave MCP

joints free to move Lower leg leave MTP joint free to

move

Knee leave knee joint free to

move.

Materials

Tubigrip (various sizes)

Use sizing tape Applicator (various sizes)

Scissors.

ApplicationWrist 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.

Knee:

Extends two-hand breadths above and below the knee joint.


Advice about washing/removal at night.

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Indications

Acute soft tissue injuries with actual or potential swelling.

Function

Minimise swelling by reducing

bleeding

Reduce pain

Reduce further injury.

Key Points

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

Limb elevated with injured area

above the level of the heart (Fig 1).

Materials

Ice (Fig 2 and Fig 3)

Plastic bag

Cloth wrapping.

Application

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).


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.

R.I.C.E. Rest, Ice, Compression, Elevation

fig 1

fig 2

fig 3

fig 1

fig 2

fig 3

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ISBN04782797

1X

ACC

Wpc 119376

Documents

Transcript of Wpc 119376