Application Technique Upper Arm Cast / Elbow Brace

Indications:

  • Fractures of the elbow.
  • Dislocations of the elbow.
  • Fractures of the lower arm.
  • Tendopathy.
  • Tendon ans ligament injuries.
  • Soft tissue injuries.
  • Positioning splint.
  • Physio purposes.
Application: The materials should be pre-prepared to enable rapid application of the bandage. All the necessary materials should be placed within reach to avoid hold-ups in the procedure.

The patient should be in a position which is comfortable to him/her and the person applying the bandage. This may vary depending on the extent of the injury, the diagnosis, the treatment method and the patient's condition.

Materials required: 1 x 5 cm and 1 x 7.5 cm Delta Cast Conformable polyester support bandages and hydrogel-coated casting gloves, adhesive bandage, toweling tubular bandage, self-adhesive fleece padding, bandage scissors, strapping, velcro tape (e.g. Orthoplast T&C), felt-tip pen, approximately 2 cm wide strip of X-ray film.

Photo 1:
The toweling tubular bandage is slipped over the hand, forearm and upper arm to protect the skin. To help with the cutting a narrow strip of unusable X-ray film is inserted beforehand. The self-adhesive fleece padding is applied to the basal thumb joint. In order to improve stability whilst maintaining the flexibility of the cast in the elbow area, a cast strip of about 3 layers produced from the 5 cm cast bandage is applied to the inner side.

Photo 2:
Starting with the 5 cm cast bandage, 2 to 3 layers are wrapped around from the hand joint upwards to the elbow. The 7.5 cm cast bandage is then wrapped around as far as the shoulder. In order to optimize the fit and bonding of the layers, the cast should be applied relatively tightly, extending it by 50% to 70%.

Photo 3:
The cast is molded for approximately 4-6 minutes. The cutting lines are then marked with a felt-tip pen. The cast is opened along the inserted strip of X-ray film using the bandage scissors and trimmed for individual fit. A notch is cut into the cast in the upper arm area in order to prevent movement of the cut edges after re-application. A large part is cut out from the elbow area to simplify the removal and re-application of the cast for checks and makes it easier to examine the injury or carry out cold therapies. The cast still retains its stability because of the longuette inserted on the inner side.

Photo 4:
The fit of the cast on the patient is then checked. A dressing which has been applied too tightly loosens by itself after opening.
If necessary, the cast can be additionally loosened by bending it open. The cast is held in place with tape to suit the patient.

Photo 5:
In order to produce an elbow brace from the finished upper arm cast, the distal part of the cast is cut off using bandage scissors. The elbow brace allows gentle rotation of the forearm whilst maintaining immobilization of abduction and adduction. Velcro tape is best method of attaching it to the patient.
An elbow brace can of course be produced direct. To do this, the cast is applied as described above but not including the wrist.

Photo 6:
The upper arm cast is attached using adhesive bandage taking into account the state of the swelling. The small number of layers means that the cast remains semi-flexible and can be adjusted depending on the individual state of the swelling (looser or tighter). To do this, the adhesive bandage is removed and the cast altered for a perfect fit. Re-application is carried out as described above. This procedure can be repeated throughout the treatment period.

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Variant:

Elbow brace: Through cutting at the distal end the supination and pronation of the lower arm can be allowed in different grades, while the flexion and extension stay restricted. The use of Hook & Loop strips ease the removal and refitting. (See also: Pict:5).

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