The fixative bandages, which include, for example, the plaster, the splint, the tape and plastic bandages, are therapeutic means of orthopedics and trauma surgery primarily for the treatment of a pathological mobility of various joints, ligament injuries and for the conservative treatment of fractures. There are different indications (areas of application) for the various types of fixative bandages, since the various clinical pictures cannot be treated equally well with each type of fixative bandage. The degree of fixation with a tape as a functional bandage cannot be compared with total immobilization by a plaster cast. Fixation can often be used to assist in the healing process.
Indications (areas of application)
- Musculature – fixation for muscular injuries is often indicated because, in addition to improved healing, there is a reduced complication rate. In the presence of distension (muscle strain), muscle stretching occurs beyond physiologic levels and does not result in tissue damage. However, further strain can cause tissue damage in the form of a muscle fiber tear, but this can be prevented with relative immobilization with a tape. If muscle fiber or muscle bundle tears have already developed, the patient may also benefit from immobilization to prevent further tissue damage. The selection of a suitable bandage must be determined together with the attending physician.
- Ligamentous injuries – ligamentous and capsular injuries represent a common indication for fixative dressings. As an important field of application for tape bandages can be called lighter injuries of joints, such as ligament strains and low-grade ligament ruptures (ligament tears). In the case of ligament injuries of the knee, conservative treatment can be carried out in the event of a distortion (twisting) by means of short-term relief in combination with subsequent muscular rehabilitation training. In the case of rupture of a collateral ligament without concomitant injuries and without instability, collateral ligament stabilizing splints represent the gold standard (therapy method of first choice).
- Tendons and muscle attachment points – with a relative immobilization in the form of a tape bandage, especially mild tendopathies (damage to a tendon) can be treated functionally.
- Musculoskeletal fatigue – chronic overuse processes of the musculoskeletal system can cause damage to the entire musculoskeletal system. Sufficient (enough / sufficient) splinting allows a fatigue fracture, which is a creeping fracture (bone fracture) due to overload, can be optimally treated with conservative measures.
- Static deformities of the skeleton – fixation using a plaster cast is particularly necessary to correct deformities, especially in the growing age. Indicated skeletal abnormalities include scoliosis (lateral bending of the spine with simultaneous rotation (twisting) of the vertebrae) and an axial deviation at the lower and upper extremities. In the case of scoliosis, either a corrective trunk cast or an orthosis is used. In the treatment of scoliosis, the trunk orthosis plays a predominant role, since the orthosis made of plastic (medical aid used to stabilize, immobilize, relieve, guide or correct e.g. the trunk) allows for improved hygiene. In the presence of skeletal changes of the foot, such as a flat foot or a splay foot (pes transversoplanus), tape bandages or splints are often used.
Contraindications
- Fractures – a tape dressing is usually contraindicated. (In the case of a cast, of course, it is not a general contraindication).
- Skin injuries
- Hematomas (bruises)
- Massive muscle contusions
- Myositis (muscle inflammation)
- Injuries in combination with arterial bleeding
- Tear of the complete tendon
- Allergic skin reactions (when using one material must be changed to another in case of allergic reaction).
Before therapy
Precise verification of the suitability of the therapeutic intervention for the disease is essential.Incorrect care of a deformity or a fracture can lead to therapy-refractory (non-treatable) changes of the skeleton. To avoid complications, a detailed history and examination should be performed regarding preexisting motion restrictions, circulatory problems, sensory restrictions (nerve damage), and skin and soft tissue changes before applying the fixative dressings.
The procedure
The basic principle of fixative bandages is to immobilize joints and correct a malposition of a joint. In addition to traditional fixation with a plaster cast, modern bandages consisting of water-polymerizing and fiber-reinforced plastics, for example, are more commonly used.
After therapy
Depending on the choice of fixative bandage and the underlying indication, regular follow-up visits are necessary. Especially in the case of a cast and the recurrence of symptoms, a compartment syndrome must be considered, which must be adequately treated as soon as possible!
Possible complications
- Pressure necrosis (death of tissue due to pressure).
- Nerve lesions (nerve damage).
- Edema (fluid accumulation in the tissue)
- Allergic reactions
- Reduction in blood flow
- Compartment syndrome (disruption of arterial and venous blood flow due to an emerging hematoma/bruise and ischemic edema/swelling due to decreased blood flow).
- Contractures (restriction of function and movement) of the musculature and joint malalignment
- Pain
