{"id":18855,"date":"2019-10-10T14:29:09","date_gmt":"2019-10-10T14:29:09","guid":{"rendered":"https:\/\/todaysveterinarypractice.com\/?p=18855"},"modified":"2024-07-02T17:22:15","modified_gmt":"2024-07-02T17:22:15","slug":"temporary-immobilization-of-limb-fractures","status":"publish","type":"post","link":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/emergency-medicine-critical-care\/temporary-immobilization-of-limb-fractures\/","title":{"rendered":"First Aid\/Temporary Immobilization of Limb Fractures With Bandages and Splints"},"content":{"rendered":"

The word coapt<\/i> means to approximate, fit together, or fasten. Coaptation<\/i> refers to the immobilization of a limb with the use of an external sling, bandage, splint, or cast. Some long bone fractures are best managed with bandages or splints for temporary \u201cfirst aid\u201d immobilization until definitive treatment via surgical fixation can be achieved; other fractures can be effectively managed with a splint or cast as the primary definitive treatment. In carefully selected instances, coaptation may be used as ancillary support for internal fixation of fractures. Coaptation for temporary first aid immobilization is discussed here; use of splinting\/casting for definitive treatment of selected fractures will be the subject of a future article.<\/span><\/p>\n

Indications for First Aid Immobilization<\/h2>\n

In cases of traumatic fracture or luxation, temporary limb immobilization improves patient comfort, controls regional soft tissue swelling, provides a protective covering for open wounds, and can prevent closed fractures from becoming open fractures via skin penetration by sharp fracture fragments. Most fractures distal to the elbow (front limb) or stifle (hindlimb) are best treated with temporary coaptation until definitive treatment can be performed. The coaptation must immobilize the joint above and below the fracture zone, as demonstrated by the purple bandage immobilizing a tibial diaphyseal fracture in <\/span>FIGURE 1<\/b><\/span>; otherwise it may only add detrimental weight to the distal limb while failing to immobilize the fracture, as demonstrated by the red bandage in this figure.<\/span><\/p>\n

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Figure 1. The coaptation should span the joint above and below the fracture. For temporary immobilization of tibial shaft fracture the purple bandage (right) would be appropriate, but the red bandage (left) would not.<\/p><\/div>\n

Selected humerus\/femur fractures or elbow luxations may benefit from temporary immobilization in a spica splint if a protracted delay until definitive treatment or lengthy patient travel is required, although most can be well managed with liberal use of analgesics and strict cage rest until surgery is performed. It is important that all wounds be treated according to the principles of open wound management as a prerequisite to temporary limb immobilization.<\/span><\/p>\n

Temporary First Aid Splint Versus Robert Jones Bandage<\/h2>\n

The Robert Jones bandage (RJB) is a highly versatile, soft, padded bandage for first aid management of many traumatic limb injuries, and the choice between its use and the use of temporary first aid splinting is largely one of personal preference and available supplies. The RJB does not require any splinting materials and is highly cost effective, but it does require the manual skill necessary to manage thick cotton rolls. Temporary first aid splints, on the other hand, use small rolls of cast padding that are easier to manage, but require various splint materials and the manual skill to manage them. The RJB is not suitable for treatment of fractures proximal to the elbow or stifle; application of a spica splint is necessary if temporary coaptation is deemed appropriate for these fracture locations.<\/span><\/p>\n

Choice of Splinting Materials<\/h2>\n

In general, the choice of splint is between a premanufactured (\u201coff the shelf\u201d) plastic or metallic splint and a custom-molded splint. Custom-molded splints are generally preferred based on their superior ability to provide bony alignment and immobilization and to minimize focal sites of irritation, but premanufactured splints can be appropriately used for some temporary immobilization situations. While prefabricated splints may offer some convenience, a substantial inventory must be maintained to allow appropriate fitting to patients of all sizes and various limb contours (e.g., front, hind, right, left). <\/span><\/p>\n

The most commonly used materials for custom molded splints are thermoplastics and fiberglass. Thermoplastic <\/span>splints are sometimes sold in perforated or nonperforated solid sheets (Orthoplast; <\/span>bsnmedical.com<\/span><\/a>), but most are sold in the form of a thermoplastic-impregnated mesh <\/span>(Vet-Lite; jorvet.com<\/span><\/a>).<\/p>\n

Thermoplastic Mesh<\/h3>\n

Thermoplastic splinting materials require the use of a hot water bath. Hot water from the faucet is insufficient to mold the material or make it self-adherent. The thermoplastic mesh is immersed in hot water (>160\u00b0F [71\u00b0C]) for 2 or 3 minutes before removal using forceps or tongs. It can then be cut, layered, and molded. Because the material is often hot during molding, the authors prefer to don 1 or 2 pairs of gloves for this step. The material should be worked well to promote adhesion between layers. If necessary, the splint can be reheated for further molding and layering. Several layers of mesh are required for most slab splint applications. The ability to cut and remold thermoplastic splints offers a potential cost efficiency since a single splint can often be remolded to the needs of several different patients over time. <\/span><\/p>\n

Fiberglass Tape<\/h3>\n

Fiberglass casting tape is impregnated with polyurethane. Fiberglass splinting materials do not require the use of a hot water bath to activate the molding and hardening process. In fact, the rate of hardening is proportional to the water immersion temperature; room-temperature water is usually best to allow adequate time for splint molding before hardening. As with thermoplastic mesh, several layers of fiberglass casting tape are required for most slab splint applications, and the casting tape should be worked to promote adhesion between layers and to remove any wrinkles. Unlike thermoplastic mesh, once fiberglass has hardened it cannot be reheated for further molding. Hardened fiberglass material typically requires a cast cutter (or similar oscillating-type saw) to cut through multiple layers. <\/span><\/p>\n

A recent mechanical comparison of thermoplastic and fiberglass splint materials showed that fiberglass produces the stiffer construct, but the relevance of this finding to the clinical first aid scenarios described in this article is likely nominal.1<\/sup><\/span><\/p>\n

Additionally, aluminum rods of various diameters (according to patient size) or even tongue depressors (for the very smallest patients) are used in some first
\naid applications.<\/span><\/p>\n

Application Techniques<\/h2>\n

The following techniques have also been published in video format.2,3<\/sup> <\/span><\/p>\n

Robert Jones Bandage<\/h3>\n

Supplies needed for the RJB are listed in <\/span>BOX 1<\/b><\/span>. Sedation or general anesthesia may be required as dictated by factors such as patient mentation, comfort, and concurrent first aid procedures. Bandage\/splint application is often performed immediately after radiography.<\/span><\/p>\n

BOX 1<\/strong> Supplies Needed for Robert Jones Bandage<\/div>
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