Professional Documents
Culture Documents
Bandaging in Dogs
FOCAL POINT and Cats: External
★ The type of bandage used for
external coaptation is often
dictated by the animal’s injury;
Coaptation*
therefore, veterinarians should be
familiar with the required The Animal Medical Center Kansas State University
materials and techniques for New York, New York MaryAnn Radlinsky, DVM, MS
applying various bandaging.
Amelia M. Simpson, DVM
Gulf Coast Veterinary Specialists
KEY FACTS Houston, Texas
Brian S. Beale, DVM
■ Tape stirrups can help prevent
bandage slippage, p. 158.
ABSTRACT: Indications for external coaptation include protecting wounds, immobilizing frac-
■ The Robert-Jones bandage is
tures, and decreasing postoperative limb swelling. The type of bandage selected for external
designed to immobilize the limb, fixation is often dictated by the animal’s injury. This article discusses some of the most com-
whereas the modified Robert- monly used bandages, including the Robert-Jones and modified Robert-Jones bandages, rigid
Jones bandage provides partial and soft casts, carpal and Ehmer slings, and metal and fiberglass splints.
immobilization, p. 159.
I
■ Permanent contracture of the n veterinary medicine, many different bandaging options are available. To
carpus is possible with the carpal provide the best external coaptation for a given injury, practitioners should be
sling but can be avoided by aware of the indications and contraindications for using these bandages. This
allowing limited extension within article reviews the most commonly used bandages, including the Robert-Jones
2 to 4 weeks after surgery, p. 160. and modified Robert-Jones bandages, soft and rigid fiberglass casts, Ehmer and
carpal slings, and metal and fiberglass splints. The indications, contraindications,
■ Only the Ehmer sling, which required materials, and application techniques for applying these bandages are
encircles the body, provides discussed.
limb abduction, p. 161.
ROBERT-JONES BANDAGES
■ Less cast padding is used under The bandage used most often in veterinary orthopedics is the Robert-Jones
splints to minimize motion bandage and its modifications.1,2 The Robert-Jones bandage should be used for
between the splint and skin, certain wounds, fractures, or dislocations at or distal to the elbow and stifle.
p. 162. This bandage is indicated when severe inflammation is expected in a patient
with a stable, nondisplaced, or nonarticular fracture but is also used if surgery is
delayed in patients with an unstable, displaced, or articular fracture.1 The goal of
the Robert-Jones bandage is to provide temporary support of a fracture through
immobilization while maintaining even compression over the entire limb.1–3
*A companion article entitled “Bandaging in Dogs and Cats: Basic Principles” appeared
in the January 2001 (Vol. 23 No. 1) issue of Compendium.
158 Small Animal/Exotics Compendium February 2001
TABLE I
Bandage Types and Materials
Type Materials Needed
Robert-Jones bandage Two pieces of 0.5- to 1-inch porous adhesive tape and tongue depressor for stirrups
Nonadherent dressing (if indicated)
One to three 1-lb rolls of 12-inch cotton
One to three rolls of 3- to 4-inch roll gauze
One to two rolls of 3- to 4-inch elastic adhesive tape
Modified Robert-Jones bandage Two pieces of 0.5- to 1-inch porous adhesive tape and tongue depressor for stirrups
Nonadherent dressing (if indicated)
Several rolls of 2- to 4-inch cast padding
One to three rolls of 3- to 4-inch roll gauze
One to two rolls of 3- to 4-inch elastic adhesive tape
Cast Rigid or fiberglass casting material
Nonadherent dressing (if indicated)
Two pieces of 0.5- to 1-inch porous adhesive tape and tongue depressor for stirrups
Several rolls of 2- to 4-inch cast padding
One to three rolls of 3- to 4-inch roll gauze
One to two rolls of 3- to 4-inch elastic adhesive tape
Slings
Carpal Nonadherent dressing (if indicated)
One roll of 2- to 3-inch cast padding
One roll of 2- to 3-inch roll gauze
Some 1-inch porous adhesive tape
One roll of 2- to 3-inch elastic adhesive tape
Ehmer Small amount of cast padding
One roll of 1- to 2-inch porous adhesive tape
Splints Mason metasplint or fiberglass splint
Two pieces of 0.5- to 1-inch porous adhesive tape and tongue depressor for stirrups
Nonadherent dressing (if indicated)
Several rolls of 2- to 4-inch cast padding
One to three rolls of 3- to 4-inch roll gauze
One to two rolls of 3- to 4-inch elastic adhesive tape
This bandage should not be used as primary fixation of of the tape near the completion of bandaging. Alterna-
a fracture because the padding can loosen over time tively, the tape can be stuck directly to itself. It is im-
and, therefore, it will not provide the rigid fixation portant to tab the ends first to allow easier separation at
needed for fracture healing.1 the end. Cotton padding should be applied, starting
Materials required include two pieces of 0.5- to 1- distally at the toes and working proximally to the mid-
inch white adhesive tape and a tongue depressor for femur/midhumerus (Figure 1B). The cotton should
stirrups, a nonadherent dressing (if indicated), one to continue to be unrolled proximally and distally, over-
three 1-lb rolls of 12-inch cotton, one to three rolls of lapping 50% per pass until sufficient bulk is achieved.1
3- or 4-inch cling gauze, and one to two rolls of 3- or The third and fourth digits must be visible to evaluate
4-inch self-adherent stretch tape (Table I). limb swelling after bandage placement. Roll gauze
Tape stirrups, which help prevent bandage slippage, should be applied next, beginning with the toes, work-
should be applied either to the medial and lateral sur- ing proximally, and overlapping each pass by 50% (Fig-
faces of the leg or the dorsal/palmar or plantar surfaces ure 1C). The gauze layer should apply strong and even
(Figure 1A). The stirrups should extend from the car- pressure to compress the cast padding by 40% to 50%
pus or tarsus to approximately 3 to 6 inches distally but should not extend beyond the layer of cast pad-
from the toes.1 A tongue depressor should be placed be- ding. The tape stirrups should be separated and taped
tween the adhesive surfaces to help facilitate separation proximally up the bandage. Finally, the outer layer
should be applied in the same fashion as the first two 50% of the proximal and distal fracture ends are in con-
layers (Figure 1D); however, care must be taken to avoid tact. The bone should be stable in the cast. A cast should
vascular compromise and swelling, which can occur if be used if the fractured bone is expected to heal quickly
the final layer is applied too tightly. The finished ban- (e.g., fractures in young animals; greenstick fractures; radi-
dage should be smooth in appearance (Figure 1D). al or tibial fractures with an intact ulna or fibula, respec-
The primary difference between the Robert-Jones tively). The cast must be used for the shortest amount of
bandage and modified Robert-Jones bandage, or soft time possible to achieve healing and minimize the possi-
padded bandage, is the amount or type of padding bility of the patient developing fracture disease. Fracture
(Table I). The modified Robert-Jones bandage uses cast disease is characterized by chronic edema, muscle atrophy,
padding instead of roll cotton and requires much less joint stiffness, and disuse osteoporosis. In extreme cases,
padding during its construction, making it consider- these changes can lead to permanent joint dysfunction. To
ably less bulky but still capable of providing compres- provide adequate stability for bone healing, the cast must
sion and partial (as opposed to complete) immobiliza- include the joint above and below the fracture.
tion (Figure 2). The modified Robert-Jones bandage is Casting materials include two pieces of 0.5- to 1-inch
indicated when light compression is needed to reduce white adhesive tape and a tongue depressor for stirrups, a
soft-tissue swelling but is not advised for any injuries nonadherent dressing (if indicated), several rolls of 2- to
that require rigid stability.1 The modified bandage is of- 4-inch cast padding, one to three rolls of 3- or 4-inch
ten used to minimize postopera- cling gauze, one to two rolls of 3-
tive swelling or provide temporary or 4-inch self-adherent stretch tape,
stability to a limb before surgery. and rigid casting material (Table I).
With the fracture in reduction,
CASTS the bandaging material should be
Rigid Casts applied the same as is done with a
Using a rigid cast as a method of modified Robert-Jones bandage ex-
fracture management is a viable cept with fewer passes of the cot-
option in several instances.9–11 Case ton roll. The casting material should
selection is important in determin- be applied over the cling gauze lay-
ing the type of cast to be consid- er. The manufacturer’s directions
ered. The fracture must be closed can be followed for preparing the
—The modified Robert-Jones bandage
Figure 2—
and located below the elbow or sti- casting material for application.
is considerably less bulky than is the Robert-
fle and should be amenable to a Jones bandage. The material should be applied be-
closed reduction in which at least ginning at the foot and continuing
coxofemoral luxations but can also be used following a non–weight-bearing sling, does not cause abduction
surgical correction of coxofemoral luxations and to pre- and allows movement of the coxofemoral joint.
vent weight bearing after repair of acetabular and A small amount of cast padding and 1- to 2-inch ad-
femoral fractures. The Ehmer sling will maintain the hesive tape are the only materials required for an Ehmer
leg in a flexed position with the coxofemoral joint in- sling (Table I). Two to three layers of cast padding
ternally rotated and abducted. Internal rotation of the should be placed around the metatarsal/proximal pha-
hip will enable the femoral head to seat beneath the langeal region (Figure 4A). The tape should then be
dorsal rim of the acetabulum, and the abduction will placed over the padding and around the metatarsal re-
help maintain reduction of the coxofemoral joint by gion (Figure 4B). With the leg flexed, the tape should
forcing the femoral head into the acetabulum.1,5 be continued up the medial aspect of the tibia, medial
The Ehmer sling should make a figure-of-eight pat- to the stifle joint, and medially over the thigh muscle
tern around the distal limb and then wrap around the with the adhesive surface of the tape always facing the
body to maintain abduction, prevent the bandage from skin (Figure 4C). The tape should be continued from
slipping off the limb, and restrict motion of the coxo- medial to lateral over the quadriceps to pass distally
femoral joint. The Ehmer sling may be problematic for caudal to the stifle joint, and medial to the distal tibia
a male dog because the encircling portion, although and hock and should pass under the plantar aspect of
cranial to the prepuce, can become soiled with urine the metatarsals, medially to laterally (Figure 4D). Two
and cause irritation. A modified Ehmer sling does not or three wraps of tape should be continued in a similar
encircle the body and may slip off the cranial aspect of manner. This completes the modified sling (Figure 4E).
the thigh. The modified Ehmer sling, which is basically With the true Ehmer sling, the tape should be carried
bandage changes as scheduled. When the pet is out- 10. Akeson WH, Amiel D, Abel MF, et al. Effects of immobi-
doors, a plastic bag can be placed over the limb to pro- lization on joints. Clin Orthop 219:28–37, 1987.
11. Rytz U, Aron DN, Foutz TL, et al: Mechanical evaluation of
tect the bandage from environmental elements. Owners soft cast (Scotchcast, 3M) and conventional rigid and semi-
should be instructed to return immediately for a bandag- rigid coaptation methods. Vet Comp Orthop Traumatol 9:
ing change if drainage or a foul odor is coming from the 14–21, 1996.
bandaging, if loosening or other structural damage to the
bandage occurs, or if the animal shows signs of obsessive
licking or chewing at the bandaging. An Elizabethan col- About the Authors
lar may be needed to eliminate the opportunity for the Dr. Simpson is affiliated with The Animal Medical Center,
pet to chew the bandaging. New York; Dr. Beale with Gulf Coast Veterinary Special-
ists in Houston, Texas; and Dr. Radlinsky with the Depart-
REFERENCES ment of Clinical Sciences, College of Veterinary Medicine,
1. Decamp CE: External coaptation, in Slatter DH (ed): Text- Kansas State University, Manhattan. Drs. Beale and
book of Small Animal Surgery. Philadelphia, WB Saunders Radlinsky are Diplomates of the American College of Vet-
Co, 1993, pp 1661–1676.
2. Fossum TW, Hedlund CS, Hulse DA, et al: Small Animal erinary Surgeons.
Surgery. St. Louis, Mosby, 1997, pp 706–708.
3. Knapp DW: Bandage techniques: Application of a Robert-
Jones bandage, in Bojrab MJ (ed): Current Techniques in
ARTICLE #3 CE TEST
CE
Small Animal Surgery. Philadelphia, WB Saunders Co, 1990,
pp 1295–1296. The article you have read qualifies for 1.5 con-
4. Jones DGC: Bandaging techniques in orthopaedics in small
animals. Vet Annual 26:202–215, 1986.
tact hours of Continuing Education Credit from
5. Fox SM: External coaptation bandages: How and when to the Auburn University College of Veterinary
use them. Vet Med 83(2):153–164, 1988. Medicine. Choose only the one best answer to each
6. Dean PW: Ehmer sling (figure-of-eight sling), in Bojrab MJ of the following questions; then mark your an-
(ed) Current Techniques in Small Animal Surgery. Philadel-
phia, WB Saunders Co, 1990, pp 1296–1298. swers on the test form inserted in Compendium.
7. Knecht CD: Principles and application of traction and coap-
tation splints. Vet Clin North Am Small Anim Pract 5(2): 1. Tape stirrups
177–195, 1975. a. should only be used for the carpal and Ehmer sling
8. Lang DN, Bartels KE: Splinting techniques, in Bojrab MJ bandages.
(ed): Current Techniques in Small Animal Surgery. Philadel-
phia, WB Saunders Co, 1990, pp 1304–1311. b. should only be used on thoracic limbs.
9. Piermattei DL, Flo GL: Small Animal Orthopedics and Frac- c. help prevent bandage slippage.
ture Repair, ed 3. Philadelphia, WB Saunders Co, 1997, pp d. are not needed for the modified Robert-Jones ban-
48–51. dage.
2. A Robert-Jones bandage should be used c. flexion (90˚) and deviated medially by 15˚.
a. as primary fixation of a fracture. d. slight flexion (15˚) and deviated medially by 90˚.
b. to provide temporary support of a proximal ra-
dius/ulna fracture through immobilization while 10. During application of a molded splint to the pelvic
maintaining even compression over the entire limb. limb, the hock should be
c. to provide temporary support of a femoral neck a. flexed 120˚.
fracture through immobilization while maintaining b. slightly extended.
even compression over the entire limb. c. extended as much as possible.
d. to provide temporary support of a proximal humer- d. flexed slightly.
al fracture through immobilization while maintain-
ing even compression over the entire limb.