Bandage and Fracture Care

Bandage and Fracture Care

• Bandage care focuses on properly applying and maintaining bandages for various reasons including fracture care.

Common Types of Fractures

• Closed Fracture: Fracture contained within the skin.
• Compound Fracture: Fracture with an open wound.
• Epiphyseal Fracture: Fracture in the growth plate of a bone.
• Greenstick Fracture: Incomplete fracture, often in children.
• Simple Fracture: Single break in the bone.
• Comminuted Fracture: Bone breaks into more than two fragments.

Types of Wound Healing

• First Intention (Primary) Healing: Internal fixation (e.g., pins, plates) used to heal rapidly.
• Second Intention Healing: Fractures heal through callus formation without internal fixation.

Principles of Bandage Application

• Prepare the area before applying a bandage.
• Use porous materials where appropriate and absorbent materials for exudates.
• Use materials of sufficient width.
• Apply materials smoothly.
• Secure protective wound pads to the skin.
• Check bandages frequently.
• Instruct clients on basic bandage care and signs of failure.

Bandage Components

• Primary Layer (Contact Layer): Layer in direct contact with the wound. Must be sterile. Allows fluid to pass to the secondary layer. Protects from contamination.
• Secondary Layer: Provides support, moves exudate away from the wound, and absorbs moisture. Thick layer to pad the wound from trauma.
• Tertiary Layer: Outermost layer, holds underlying layers together. Can be porous adhesive (allowing evaporation) or elastic adhesive (applying pressure).

Bandage Components (Specific Dressing Types):

• Dry-to-Dry Dressing: Use for loose necrotic tissue or foreign material. Dry gauze on wound, absorbent layer, allow fluid to dry, remove. Painful; sedate the animal for removal.
• Wet-to-Dry Dressing: Use for viscous exudate; remove dried foreign material first, apply wet, allow to dry.
• Wet-to-Wet Dressing: Transports heat to wound, enhances capillary action; applied wet, stays wet. Less painful removal.

Examples of Dressing Material

• Adherent: Gauze, non-cotton filler.
• Nonadherent: Adaptic, Release, Telpha pads.

Secondary Layer

• Provides support.
• Moves exudates away from the wound.
• Should be thick enough to absorb moisture, pad the wound, and inhibit movement.

Tertiary Layer

• Outer layer.
• Holds underlying bandage layers in place.
• Porous adhesive allows evaporation of fluid but could allow fluid (e.g., saliva) into the wound.
• Elastic adhesive applies continuous dynamic pressure as the animal moves.

Types of Bandages: Robert Jones Bandage

• Temporarily immobilizes distal elbow or stifle fractures.
• Supports injured soft and bony tissue.
• Prevents excessive swelling.
• Not appropriate for femur or humerus fractures.

Robert Jones Bandage Technique

• Wrap cotton tightly around the area to avoid wrinkling/twisting.
• Wrap cotton with Kling gauze tightly.
• Press tape stirrups to the side of the bandage.
• Apply self-adherent elastic tape or vet-wrap from toes upward.
• In horses, stirrups are not used; start on the inside of the leg.

Modified Robert Jones Bandage

• Less bulky because padding is limited.
• Used for postoperative swelling reduction.

Modified Robert Jones Bandage: The Primary or Contact Layer

• Primary or contact layer and antimicrobial therapy application should be sterile.

Types of Bandages: Ehmer Sling

• Used after hip luxation reduction.
• Keeps the femoral head deeply seated in the acetabulum.

Ehmer Sling Technique

• Wrap cast padding around the metatarsal area and cover with elastic adherent tape.
• Manually flex the stifle, keeping the femur rotated inward.
• Continue the elastic tape from the metatarsal region to the stifle, then to the hock, creating a figure-8 pattern.
• Abduct the limb by passing the tape dorsally over the back.
• Incorporate the knee into the wrap.
• Monitor for swelling.

Types of Bandages: Velpeau Sling

• Prevents weight-bearing on the forelimb.
• Indicated for scapular fractures and shoulder dislocations.
• Avoid if animal has thoracic trauma or disease.

Velpeau Sling Technique

• Flex carpus and metacarpus to a comfortable position and wrap.
• Flex the antebrachium across the cranial chest wall, with the paw pointing toward the opposite scapulohumeral joint.
• Apply additional wraps around the chest and flexed limb.

Types of Bandages: Casts

• Provides support for fractures.
• Materials include fiberglass casting material and plaster casting.
• General anesthesia is required.
• The skin should be clean and dry.
• Padding should only be used at pressure points; not for equine or bovine.

Casts (Continued)

• The cast should immobilize the joints proximal and distal to the lesion.
• Assistants should use the flat portion of their hand to support the limb during application.
• Examine every 6-8 hours the first day after application.

Bandage Removal

• Remove outer layer with scissors.
• Tear cotton (distal to proximal).
• Casts are removed with an oscillating saw (Stryker).
• Splints can be removed with bandage scissors.

Home Care of Bandages

• Educate clients on daily monitoring of toes for warmth, swelling, and color.
• Monitor for foul odors and chafing areas.
• Prevent the animal from chewing on the bandage.
• Protect bandage when outside.
• Do not leave a plastic bandage cover on longer than 30 minutes.