Application Technique Tutor

Indications:

  • Fractures of the knee joint.
  • Ligament instability of the knee joint.
  • Soft tissue injuries.
  • Tendon and ligament 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: 3 x 10 cm Delta Cast Conformable polyester support bandage and hydrogel-coated casting gloves, adhesive bandage, tubular bandage, Delta Rol S padded wadding or toweling tubular bandage, bandage scissors, felt-tip pen.

Photo 1:
In order to achieve maximum stability in the knee joint area, a 2-layer longuette (4 layers in the knee area) is prepared from a cast bandage and applied to the outer side. A toweling tubular bandage is applied beforehand or, as shown here, padding with synthetic elastic wadding (Delta-rol S) over a tubular bandage. In compression therapy, this special padded wadding can be applied underneath the cast bandage. This allows treatment of swollen soft parts and at the same time acts as thrombosis prophylaxis.

Photo 2:
Starting at the distal end, 2 to 3 layers of cast are applied using circular movements. It should be applied relatively tightly (extending it by about 50 to 70%). This improves the bonding of the layers and the fit of the tutor. Fears that this will make the tutor too tight are unfounded because the cast becomes looser after opening. The use of the longuette makes the cast very stable in the rear knee area (7 to 8 layers) whilst retaining flexibility in the front knee area (2 to 3 layers).

Photo 3:
The cast is molded for approximately 4-6 minutes. In order to prevent the tutor from slipping later, particular care is taken with the molding of the femur condyles. Any folds occurring in the thigh area can be easily smoothed out by pulling the proximal end of the cast.

Photo 4:
Following the molding phase (4 to 6 minutes) the cutting lines are marked and the cast opened. It is then trimmed for individual fit using bandage scissors. Two notches are cut in the cast to avoid movement of the cut surfaces after re-application. A large part of the cast is cut away in the knee joint area. This simplifies the removal and re-application of the cast during check-ups and any examinations of the injury or cold therapies.

Photo 5:
The fit of the cast on the patient is then checked. If necessary, the cast can be loosened by bending open or made tighter by cutting out a strip of about 1 to 2 cm. The cast is put in place on the patient using an adhesive bandage, taking into account the state of the swelling.

Photo 6:
The tutor dressing is completed after pulling on the tubular bandage left at the distal end. The tutor can be changed into a knee brace by shortening the cast at the distal and proximal ends using bandage scissors. The dressing can be held in place using velcro tape if required.

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 duration of treatment.

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Variant:

Knee brace: The tutor cast can get turned into a short knee brace by cutting the distal and proximal ands off with bandage scissors, or it can be applied directly as knee brace.
The application technique is the same, expect that the cast is applied in a short version. By applying Hook & Loop strips to affix the cast to the patient the placement and removal of the cast are made much easier. If this variant is chosen, the Hook tape gets fixed to the -not yet hardened- cast with a wet semielastic bandage. During polymerization the Hook tape gets "glued" to the cast. The subsequent gluing or riveting is not necessary. (See also: Tibia brace).

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