Practical Techniques in Injury Management

C ASTS A N D S P L I N TS

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

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

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 difcult. 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 nd it contains new techniques that are useful, while for others it will serve as a reminder of some of the ner 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 Ofcer Accident Compensation Corporation

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 Proles for relevant diagnostic tests.
fig 1

Function
Immobilise elbow and wrist allowing full movement of ngers.

Key Points
Refer to Treatment Proles for time off work guidelines Often used when transporting to secondary site for denitive 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).
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 rmly (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

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 Proles for relevant diagnostic tests.
fig 1

Function
To provide immobilisation allowing movement of ngers and elbow and to allow rotation of forearm.

Key Points
Refer to Treatment Proles for time off work guidelines Often used when transporting to secondary site for denitive treatment and or diagnosis.

Position
fig 2

Materials
Stockinet Cast padding POP slab double thickness Bandage and sling.

Wrist in neutral (Fig 3) Proximal limit 4cm distal to elbow crease Distal limit proximal palmar crease.

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.

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 Proles for relevant diagnostic tests.

Contra-indications
Acute injuries or gross swelling.
fig 1

Function
Immobilise wrist Allow full movement of MCPs and elbow.

Key Points
Refer to Treatment Proles for time off work guidelines.

Position
Wrist in neutral Proximal limit 4cm distal to elbow crease Distal limit proximal palmar crease.

Materials
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 nish (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.

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 Proles for relevant diagnostic tests.

Contra-indications
fig 1

Acute fractures Swelling of wrist, forearm or elbow.

Function
Provides immobilisation of elbow and wrist while allowing full movement of ngers Prevents rotation of forearm.
fig 2

Key Points
Refer to Treatment Proles for time off work guidelines.

Position
Forearm in neutral/pronation/ supination Limb held by assistant Elbow at 90 Proximal limit axilla, leaving shoulder free Distal limit proximal palmar crease.

Materials
Stockinet Cast padding POP slabs as shown 2-3 rolls 7.5-10cm POP.

fig 3

Application
Cut POP as indicated (Fig 1) Assistant to hold ngers 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 gure 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 t Broad arm sling.

fig 4

fig 5

Post Application Follow-up

Cast care instructions given in multiple languages Cast check 24 hours Follow-up dependent on injury.

Below Knee Complete Cast(Adult)

Indications
Post-acute fractures of ankle and foot Refer to Treatment Proles for relevant diagnostic tests.

Contra-indications
Swelling of ankle and foot Acute injury (use below knee back slab).

90o
fig 1

Function
To immobilise ankle and foot while allowing movement of toes and knee joint.

Key Points
Refer to Treatment Proles for time off work guidelines. Avoid common peroneal nerve behind bular neck.

Position
Ankle at 90 Proximal limit tibial tuberosity, and 1cm below (distal to) bular 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.
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 t 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 nish.
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.

Below Knee Backslab (Adult)

Indications
Acute fractures of tarsals / metatarsals Acute fractures of distal tibia/bula Severe soft tissue injuries of foot, ankle or lower leg Refer to Treatment Proles for relevant diagnostic tests.

Function
fig 1

Key Points
Refer to Treatment Proles for time off work guidelines Often used when transporting to secondary site for denitive treatment and/or diagnosis Avoid common peroneal nerve.

Ankle immobilisation for acute lower leg, ankle or foot injuries.

Position
fig 2

Materials
Wedge Assistant Cast padding 15cm crepe bandage 15-20cm POP slab double thickness 10cm POP slab for ankle struts.

Ankle at 90 Proximal limit tibial tuberosity, and 1cm below (distal to) bular head to avoid damage to common peroneal nerve Distal limit web of toes.

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 t from tibial tuberosity and distal to bular 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 ex 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.

fig 5 Below knee cast incorrect

Below knee cast incorrect

POP proximal to tibial tuberosity Ankle inverted and plantarexed POP too distal covering little toes

fig 4 POP wrinkled at ankle.

10

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 Proles for relevant diagnostic tests.

Function
Provides immobilisation in position of function of wrist, hand and ngers.

Key Points
fig 1

All ngertips must be visible to allow easy assessment of circulation Refer to Treatment Proles for time off work guidelines Discussion or referral to Specialist is recommended for all hand and nger fractures.
fig 2

Position
Wrist 45 dorsiexion MCP joints 90 Fingers fully extended Proximal limit 4cm distal to elbow crease Distal limit to nger tips.

Materials
Stockinet Cast Padding 10cm POP slab Bandage.

fig 3

Application
Apply stockinet covering all of hand and ensuring it extends far enough past ngertips 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 ngertips to 4cm distal to elbow crease. Trim to t neatly around thumb Wet slab and apply to hand and forearm (Fig 3) Turn stockinet edges down ensuring that all ngertips 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

Scaphoid Cast
Indications
Suspected or clinical fracture of scaphoid Signicant delay in Xray or specialist assessment If fracture is conrmed 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 Proles 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.

fig 1

Function
To hold the thumb in opposition and immobilise wrist.

Key Points
Refer specialist opinion Follow up essential Refer to Treatment Proles for time off work guidelines.

fig 2

Position
Thumb in opposition Middle nger 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

Materials
Stockinet Cast Padding 10cm slab as diagram 1-2 rolls 7.5cm POP.

fig 3

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 t 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 Denite 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

Bennetts Cast
Indications
Fracture to base of thumb metacarpal (Bennetts fracture) See Treatment Proles for relevant diagnostic tests.

Function
Provides immobilisation of thumb while allowing full movement of ngers.

Key Points
Tip of thumb must be visible to allow easy assessment of circulation Refer to Treatment Proles for time off work guidelines Referral to, or discussion with, specialist is recommended for all Bennetts fractures.
fig 1

Position
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.

Materials
Stockinet Thumb stockinet Cast padding 10cm slab for reinforcing (Fig 3) 1-2 rolls 7.5cm POP.
fig 2

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 nish (Fig 6) Mould well around base of thumb and thenar eminence (Fig 7), keeping thumb abducted Broad arm sling.

fig 3

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

Cast Check
Below elbow cast correct

Indications
Immediately post application At one day 24 hours At any time concerns arise.

Function
fig 1

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 Proles for relevant diagnostic tests and time off work.

Below elbow cast incorrect

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
fig 2
POP too distal to palmar crease POP not close enough to elbow Pressure crease at wrist.

Specific Advice
Elevation advice Crutches demonstration and advice Weight-bearing restrictions Slings Patient-driven problem solving.

Appropriate for choice of cast.

Below knee cast correct

Procedure
Post-application check Check that the appropriate cast has been applied Ask the patient about comfort and t 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 t 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.

fig 3

Below knee cast incorrect

fig 4 Below knee cast incorrect

POP proximal to tibial tuberosity Ankle inverted and plantarexed 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

Buddy Strapping Fingers and Toes

Indications
Joint injuries of ngers Some simple fractures of phalanges or metacarpals.

Function
Mobilisation Support.

Key Points
Tape leaves PIP and DIP joints free to mobilise.
fig 1

Position
Leaves DIP and PIP joints free.

Materials
1cm zinc oxide tape Gauze padding Scissors.

Application
Pre-cut gauze to t between toes and t in place (Fig 4) Gauze may also be used for ngers Apply two pieces of tape to hold ngers/toes together (Fig 2 and 5) Ensure nger 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

Mallet or Stax Splint Finger

Indications
Mallet nger injuries including Extensor tendon injuries Extensor tendon avulsion fractures of base of terminal phalanx.

Function
fig 1

Key Points
DIP Joint must be neutral or mildly hyper-extended Instruction sheet essential for selfmaintenance The key is not to let the DIP ex even slightly during the period of immobilisation.

Immobilisation (DIP Joints) to allow healing of fracture/scarring of extensor apparatus.

Position
fig 2

Materials
1cm zinc oxide tape 2cm elastoplast tape Splints (various sizes) Scissors.

DIP Joint hyperextended (Fig 2) or neutral Ensure the plastic splint is not loose tting (results in extension lag).

Application
fig 3

Add tubinette and talcum, then apply 1cm tape to nger in gure 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 gure 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

Splint Knee
Indications
Acute knee injuries including Contusions/sprains Patella fractures Ligamentous tears.

Function
Immobilisation Support.

Key Points
fig 1

Partially immobilises knee joint Temporary splint only Early referral if diagnosis/ management unclear.

Position
Knee extended.

Materials
Knee splint Crutches +/- Tubigrip.

fig 2

Application
Patients leg horizontal (Fig 2) Patella sits in keyhole (Fig 3) Velcro strap rmly 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

Velcro Brace Wrist

Indications
Wrist injuries including Sprains Tenosynovitis Contusions to wrist.

Function
fig 1

Key Points
Immobilises wrist Temporary splint only Early referral if diagnosis/ management is unclear.

Immobilisation Support.

Position
Position of function of wrist and hand.
fig 2

Materials
Velcro wrist splint.

Application
Establish most appropriate size of splint ( Fig 2) Fit rmly 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

Spica Strapping Thumb

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 Temporary splint only Early referral if diagnosis/ management is unclear.

fig 1

Position
Thumb in neutral.

Materials
2cm elastoplast tape Scissors.
fig 2

Application
Apply in gure 8 method (Fig 3) starting distally and overlapping by moving proximally down thumb (Fig 4) Apply nal strip in gure 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

Taping Knee
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.

fig 1

Position
Standing 10 20 leg exion (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).

fig 2

Post Application Follow-up

Two to four days for review Self-removal if irritation present Emphasise isometric static quadriceps exercises.

fig 3

fig 4

fig 5

fig 6

20

Taping Ankle
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.

fig 1

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).
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

Sling High Arm

Indications
Injuries to hand, ngers and wrist To elevate an injured area above the heart, including: Signicant wounds Fractures Dislocations Tendon injuries Soft tissue injuries.

fig 1

Function
Immobilisation Elevation Support.

Key Points
High arm sling provides better hand elevation than broad arm sling.

Position
fig 2

Materials
Sling Scissors.

Injured limbs hand on opposite shoulder.

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).

fig 3

Post Application Follow-up

Advice about showering/night-time removal Relevant to specic injury.

22

Sling Broad Arm

Indications
Forearm fractures Casts including below elbow casts Some shoulder injuries fractured clavicles a-c joints Elbow injuries.

fig 1

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 nger and hand injuries.

Position
Elbow at 90 exion.

Materials
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 specic injury.

23

Sling Collar and Cuff

Indications
Hanging casts Humerus fractures proximal or shaft.

Function
fig 1

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.

Immobilisation Elevation Support.

Position
fig 2

Materials
Collar and cuff material Scissors.

Elbow at 90 exion Greater exion may be required for some elbow injuries.

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 specic injury.

24

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
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.
fig 1

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.

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. Knee: Extends two-hand breadths above and below the knee joint.
fig 3

Post Application Follow-up

Advice about washing/removal at night.
fig 4

fig 5

fig 6

25

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

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 rst 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.

fig 1

fig 2

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).

fig 3

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

ISBN 047827971X ACC2373