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Musculoskeletal: Robert Jones bandage

ISSN 2398-2977


Introduction

  • Evenly distributed pressure and relative rigidity is achieved by compression of air filled multilayered cotton wool layers using gauze bandages.

Uses

  • First aid support for fractures Musculoskeletal: fracture - first aid or injured suspensory apparatus Flexor tendon: trauma.
  • Minimize post-traumatic edema and hemorrhage by application of counter-pressure.
  • Supportive bandage following removal of cast or splint.
  • Stabilization of wounds prior to, and after, closure
  • Temporary protection of internal fixation devices, soft tissues wounds and surgical sites during anesthetic recovery Anesthesia: recovery - overview. Subsequently during early convalescent period.

Advantages

  • Easy and quick to apply.
  • Requires minimal equipment (but large amounts of cotton wool and open weave bandages).
  • Often used in conjunction with splints to add further support and rigidity.
  • Half and full limb versions can be applied to the fore and hindlimb.

Disadvantages

  • Final bandage can be very heavy and create a pendulum effect on affected limb.
  • Does not provide complete immobilization for long period, as bandage will loosen.
  • Does not provide as good vertical support to limb as a cast Musculoskeletal: external fixation - casts.

Technical problems

  • Needs to maintain an awareness of the normal contours of the limb - the bandage should be of even thickness.

Alternative techniques

Time required

Preparation

  • Half limb - 5 min.
  • Full limb - 5-10 min.

Procedure

  • Half limb - 15 min.
  • Full limb - 20 min.

Decision taking

Criteria for choosing test

  • Available materials.
  • Type of injury.
  • Time to surgery, or in transport.

Requirements

Personnel

Veterinarian expertise

  • Experience in applying bandages to horses’ limbs.

Nursing expertise

  • Experience in applying bandages to horses’ limbs.

Materials required

Ideal consumables

  • Full limb:
    • 10 x 500 g (1 lb) rolls of absorbent cotton wool Musculoskeletal: Robert Jones bandage 01.
    • 20 x gauze bandages.
    • Non-elastic adhesive tape.
    • Splints as necessary.
  • Half limb: approximately half the amount for a full limb.

Preparation

Site preparation

  • Wounds or surgical sites will require covering with a suitable dressing held in place by orthopedic padding prior to application of the bandage.

Restraint

Technique

Approach

Step 1 - Apply first layer

  • Several layers of 2.5 cm thick cotton wool are wrapped snugly around the limb from foot (bulbs of heel) up to the elbow for a full limb bandage, to the carpus or hock for a half-limb bandage Musculoskeletal: Robert Jones bandage 02Musculoskeletal: Robert Jones bandage 03. This first layer of cotton wool should be about 3cm thick. Splitting a roll into half improves the ability to apply it evenly to the leg.
  • Wrap gauze bandage firmly and evenly over the cotton wool to compress it the same over the entire bandage. Each width of the gauze should overlap the next by 50%.
  • The surface should have a firm and even appearance but easily indent on finger pressure Musculoskeletal: Robert Jones bandage 04.

Core procedure

Step 1 - Apply several more layers 

  • Repeat the cotton wool and gauze layering Musculoskeletal: Robert Jones bandage 05, maintaining firm even pressure, until the diameter of the bandage is about three times that of the limb.
  • The cotton wool often tends to build up in the middle of the bandage and narrows at the end. This should be compensated for by adding additional layers at the ends which are then covered by another layer of cotton to incorporate them into the overall bandage. This stops any weak points where the additional material meets the rest of the bandage material.
  • At least 3 layers are usually used (minimum thickness of 6-8 cm) to give maximum support, but some people will use one or two layers where lesser support is required.
  • Finish with a layer of gauze.
  • After the final layer is applied the bandage should make a sound like a ripe watermelon when tapped with a finger.
  • For full limb bandages of the fore or hind limb particular care has to be taken of the accessory carpal bone in the fore limb or the point of the hock/calcaneal tendons in the hind limb. In these locations the layer of conforming bandage should be placed in a figure-of-eight conformation to avoid placing excessive pressure on the bony prominences in these anatomical areas. The final outside layer can also be placed in a similar manner or, alternatively, an incision made into the layer over the prominences after application. In addition, a doughnut-shaped cotton ring can be placed over the accessory carpal bone, or soft cotton pads applied medially and laterally between the tibia and gastrocnemius tendon in the hindlimb.

Step 2 - Apply splints

  • Depending on the individual’s case details, a splint(s) may be required in addition to the bandage Musculoskeletal: fracture - first aid.
  • ​Splints help stabilize and support the limb further within the bandage thereby improving the results of first aid treatment and lessening further trauma.
  •  Positioning of the splints in relation to the injury is very important.

Exit

Step 1 - Apply non-elastic adhesive tape 

  • Secure the splints, if applied with non-elastic tape.
  • If no splints are to be used, just wrap the limb after a final gauze layer, with a single layer of overlapping 7.5 cm non-elastic tape Musculoskeletal: Robert Jones bandage 06, eg Elastoplast, maintaining even firm pressure. The entire length of the bandage is incorporated, including above and below the ends, to prevent dirt and bedding material entering the bandage. Distally this means underneath the heel bulbs where it can be sealed by an impervious tape to prevent increased contamination.
  • When finished the bandage should be an even tubular structure around the limb.
  • In the full limb versions in the fore and hind limb it is essential the bandage finishes high enough to prevent the carpus and tarsus flexing and limiting the bandage’s effectiveness.

Aftercare

Immediate Aftercare

Monitoring

  • Twice daily assessment of the bandage and horse to identify any change in use of the leg or change in fit of the bandage.
  • Any strike through of exudate or blood in the bandage should warrant an immediate change of bandage.

General care

  • Replace bandage every 2-3 days or sooner if it loosens.

Wound protection

  • Change dressings at each bandage change.

Potential complications

  • Bandage-induced skin rubs or pressure sores.
  • Twisting or change in position of bandage and/or splints warrants an immediate replacement of the bandage/splints.
  • Inadequate stability leads to movement at wound or fracture site.

Long term Aftercare

Follow up

  • Robert Jones bandages can be kept in place for prolonged periods with careful application and followup.

Outcomes

Complications

  • Skin rubs and pressure sores.
  • Inadequate support to limb.
  • Problems relating to splint application and maintenance.

Reasons for treatment failure

  • Incorrect application and/or materials.

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Eggleston R B (2018) Equine Wound Management: Bandages, Casts, and External Support. Vet Clin North Am Equine Pract 34 (3), 557-574 PubMed.

Other sources of information

  • Bramlage L R (2020) First Aid and Transportation of Equine Fracture Patients. In: Equine Fracture Repair. 2ne edn. Ed: Nixon A J. Wiley Blackwell, USA. pp 83-90.
  • Wright I M (2020) Racetrack Fracture Management and Emergency Care. In: Equine Fracture Repair. 2nd edn. Ed: Nixon A J. Wiley Blackwell, USA. pp 44-82.
  • Bischofberger A S (2018) Drains, Bandages and External Coaptation. In: Equine Surgery. 5th edn. Eds: Auer J, Stack J, Kummerle J M & Pange T. Elsevier, USA. pp 280-300.