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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
Refer to Treatment Profiles for relevant diagnostic tests.
Function
To provide immobilisation allowing
movement of fingers and elbow
and to allow rotation of forearm.
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 (Fig 3)
Proximal limit 4cm distal to
elbow crease
Distal limit proximal palmar
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
Refer to Treatment Profiles for relevant diagnostic tests.
Contra-indications
Acute injuries or gross swelling.
Function
Immobilise wrist
Allow full movement of MCPs and
elbow.
Key Points
Refer to Treatment Profiles 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.
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.
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.
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
Refer to Treatment Profiles for relevant diagnostic tests.
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
Refer to Treatment Profiles 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.
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.
Post Application Follow-up
Cast care instructions given in multiple languages
Cast check 24 hours
Follow-up dependent on injury.
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Indications
Post-acute fractures of ankle and foot
Refer to Treatment Profiles for relevant diagnostic tests.
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
Refer to Treatment Profiles for time
off work guidelines.
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.
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 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
Refer to Treatment Profiles for relevant diagnostic tests.
Function
Ankle immobilisation for acute
lower leg, ankle or foot injuries.
Key Points
Refer to Treatment Profiles for time
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.
Below knee cast incorrect
fig 4
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Indications
Finger and hand fractures
Finger, hand, tendon and ligament injuries
Severe soft tissue injuries of the hand
Refer to Treatment Profiles for relevant diagnostic tests.
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
Refer to Treatment Profiles for time
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
Proximal limit 4cm distal to
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.
Post Application Follow-up
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
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.
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.
Post Application Follow-up
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
Refer to Treatment Profiles for time
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)
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.
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.
Post Application Follow-up
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
Below knee cast incorrect
POP proximal to tibial tuberosity
Ankle inverted and plantarflexed
POP too distal covering little
toes
POP wrinkled at ankle.
Below knee cast incorrect
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.
Post Application Follow-up
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.
Post Application Follow-up
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.
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.
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Indications
Wrist injuries including
Sprains
Tenosynovitis
Contusions to wrist.
Function
Immobilisation
Support.
Key Points
Immobilises wrist
Temporary splint only
Early referral if diagnosis/
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).
Post Application Follow-up
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
Temporary splint only
Early referral if diagnosis/
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).
Post Application Follow-up
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).
Post Application Follow-up
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).
Post Application Follow-up
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).
Post Application Follow-up
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.
Post Application Follow-up
Advice about showering/night-time removal
Relevant to specific injury.
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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.
Post Application Follow-up
Advice about showering/night-time removal
Relevant to specific injury.
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.
Post Application Follow-up
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).
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.
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