Casts and bandages are frequently used to treat orthopaedic conditions, especially in situations where clients have financial constraints that rule out surgical treatment.

Necrotic foot
Necrotic foot: a complication after inappropriate monitoring of a Robert Jones bandage (zoom).

However, these techniques have an extremely high probability of complications, including:

  • malunion, delayed or non-union
  • fracture disease – which refers to joint stiffness, muscle atrophy and disuse osteopenia associated with prolonged casting

And, most commonly:

  • soft tissue injury – ranging in severity from mild dermatitis or pressure sores to sepsis and avascular necrosis of tissues

Check and check again

Although avoidance of using coaptation techniques is recommended, very stringent case selection may help to reduce the risk of complications occurring.

If you do end up having to attempt external coaptation, the most important thing to do is to schedule very regular checks and re-application of the cast or bandage.

Get clients to monitor for:

  • any unusual smells coming from the bandage
  • changes in the way the patient walks, e.g. increase in lameness
  • discolouration of the bandage
  • any signs of pain or irritation

Always err on the side of caution and schedule the checks more frequently than you think you should, otherwise you could end up with a situation as seen in the image above.

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