Application Technique Lower Leg

Indications:

  • Fractures of the distal lower leg.
  • Fractures of the tarsal bones.
  • Fractures of the metatarsals.
  • Tendon and 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 7.5 cm and 1 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:
Application of a tubular bandage which should be double the length of the limb. A special padded bandage (Delta rol S) can be used underneath the cast for parallel compression therapy. Alternatively, a toweling tubular bandage can be used for padding. A ready prepared longuette can be applied in order to improve the stability in the area of the foot/upper ankle joint (3 layers in the foot area, 2 layers in the Achilles tendon area).

Photo 2:
The cast is wrapped around using circular movements, with 2 to 3 layers in the upper ankle joint area, 2 layers in the calf area and 1 layer in the proximal part. The cast should be applied relatively tightly extending it by about 50% - 70%. The varying number of layers produces a stable cast in the foot/ upper ankle joint area and a soft, flexible cast in the calf area.

Photo 3:
Following the molding phase of 4 to 6 minutes, the cutting lines are marked with a felt-tip pen.

Photo 4:
The cast is opened on the outer side using bandage scissors. If the dressing has been applied too tightly, it will loosen by itself after opening (special feature of Delta Cast Conformable).

Photo 5:
Bandage scissors are used to trim the cast for individual fit. In order to avoid movement of the cut surfaces following re-application, a notch is cut in the cast, away from the fracture. A large part of the cast is removed in the upper ankle joint area. This simplifies the re-application and makes it easier to examine the injury or carry out cold therapies

Photo 6:
The cast is fixed in place with an adhesive bandage taking into account the individual state of the swelling. Finally, the tubular bandage is pulled over the cast.
The finished lower leg cast provides stability in the ankle joint area and flexibility for the calf and the area above the foot.
The opened version should be used for immobile patients. A cast applied using the same technique but not opened is stable under load and can be used for a mobile patient.

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Variant:

Short-cast-boot: This bandage ends proximaly about 15 cm above the malleoli.
It can be cut from a lower leg cast or be applied directly in the short version.
(See: Ankle brace and metatarsalshoe variant Combicast).

Long-cast-boot by Sarmiento: Here the cast gets applied up to the proximaly about 10 cm above the rim of the patella. After modellation it gets cut so that uninhibited stretching and bending in the knee is possible. The kneecap runs in an arch around the femoral condyles and the upper rim of the patella.

Achillestendon orthesis: Allows early functional treatment from a dorsaly splint cast-orthesis. The plantarflexion of the foot can be controlled, if wanted, while the dorsal extension of the foot can be avoided at the desired ankle.

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