Elastic Wrap Research Articles

A Prospective, Randomized Clinical Investigation of the Treatment of First-Time Ankle Sprains

Background Acute ankle ligament sprains are treated with the use of controlled mobilization with protection provided by external support (eg, functional treatment); however, there is little information regarding the best type of external support to use. Hypothesis There is no difference between elastic wrapping, bracing, bracing combined with elastic wrapping, and casting for treatment of acute, first-time ankle ligament sprains in terms of the time a patient requires to return to normal function. Study Design Randomized controlled clinical trial; Level of evidence, 1. Methods Patients suffering their first ligament injury were stratified by the severity of the sprain (grades I, II, or III) and then randomized to undergo functional treatment with different types of external supports. The patients completed daily logs until they returned to normal function and were followed up at 6 months. Results Treatment of grade I sprains with the Air-Stirrup brace combined with an elastic wrap returned subjects to normal walking and stair climbing in half the time required for those treated with the Air-Stirrup brace alone and in half the time required for those treated with an elastic wrap alone. Treatment of grade II sprains with the Air-Stirrup brace combined with the elastic wrap allowed patients to return to normal walking and stair climbing in the shortest time interval. Treatment of grade III sprains with the Air-Stirrup brace or a walking cast for 10 days followed by bracing returned subjects to normal walking and stair climbing in the same time intervals. The 6-month follow-up of each sprain severity group revealed no difference between the treatments for frequency of reinjury, ankle motion, and function. Conclusion Treatment of first-time grade I and II ankle ligament sprains with the Air-Stirrup brace combined with an elastic wrap provides earlier return to preinjury function compared to use of the Air-Stirrup brace alone, an elastic wrap alone, or a walking cast for 10 days.

Stump management after trans-tibial amputation

In order to achieve stump healing after trans-tibial amputation, various methods are applied, such as soft dressings followed by elastic wrapping of the stump, rigid dressings, semi-rigid dressings, and more recently the application of silicon or gel-liners. A systematic literature search was performed to identify the optimal post-amputation management. The methodological quality of the studies was systematically evaluated by using a predefined list of criteria. Only 11 controlled studies were identified and evaluated for their methodological quality. From these studies, no studies were classified as A-level studies, whereas three were classified as B-level, and 8 were classified as C-level studies. Relevant literature appears heterogeneous with respect to patient selection, intervention and outcome measures. Despite the large variability of included studies, this review reveals a trend in favour of rigid and semi-rigid dressings for achieving stump healing and reduction of stump volume. No conclusions can be drawn with regard to the effect on functional outcome. The literature is not conclusive on the effects of early weight bearing on stump healing, volume reduction, and functional outcome. More research is needed for the development of evidence-based clinical practice guidelines concerning management after transtibial amputation.

Reduction of a Large Incarcerated Rectal Prolapse By Use of an Elastic Compression Wrap

Reduction of a large rectal prolapse may be difficult because of significant edema that collects in the rectal tissues. If reduction is unsuccessful, an emergent laparotomy and internal reduction is required. A wide elastic wrap applied around the prolapsed rectum provides progressive compression, which reduces the amount of edema, allowing subsequent manual reduction. This novel technique is simple, safe, inexpensive, and can easily be performed in the emergency department setting. Manual reduction, by this or other described methods, should be attempted before emergent laparotomy for incarcerated rectal prolapse is performed.

An informal discussion of emergency nurses' current clinical practice: What's new and what works

Stephanie Baker, RN, BSN, MBA/HCM, CEN, MICN, Director of Emergency Services at Paradise Valley Hospital in National City, California, tells me that an orthopedic sales representative at her institution gave her this tip for keeping the correct angle in a short leg posterior splint. In order to keep the foot at a 90-degree angle until the splinting material hardens (to avoid foot drop), she has the patient sit upright on the stretcher after the splint has been applied, with the affected leg extended out in front. She then takes a one-inch piece of plastic tape and, starting about halfway down the foot, brings the tape up over the toes and then down to the top of the elastic wrap (just below the knee). She tucks the edge under the elastic wrap and allows the patient to sit while she prepares the crutches and discharge instructions. Baker tells me that this holds the splint in a stable position for several minutes while the splinting material hardens, assuring that the splint is maintained in the desired position.

Axiom or Myth? Always X-ray and Splint Every Ankle Sprain

Axiom or Myth? Always X-ray and Splint Every Ankle Sprain

COMPARISON OF A FOCAL COMPRESSION SLEEVE WITH GENERALIZED COMPRESSION IN THE TREATMENT OF ACUTE ANKLE SPRAINS

Objective The ankle sprain is the most common injury in the athletic population. The occurrence and persistence of soft tissue swelling with resultant decreases in range of motion and strength is believed to delay the return to full activity more than any other factor. In theory, prevention of swelling with focal compression will decrease loss of function and result in a more rapid recovery compared to the accepted standard of generalized compression. The purpose of this study is to evaluate the degree of influence focal compression over the potential spaces of the ankle has on the duration to full recovery compared to generalized compression. Methods The study design was a pre-test - post-test control group design with randomization at a military training academy. All first year officer candidates who sustained a grade 1 or 2 ankle sprain during a 2-month indoctrination program were randomized to one of two groups. The control group was treated with an elastic wrap providing generalized compression and the intervention group treated with a commercially available sleeve providing focal compression. Subjects were followed from the time of initial presentation to return to full activity. Independent t-test for differences between the treatment groups and dependent t-test for differences within treatment groups were used to examine data. Results Fifty participants were enrolled in the study (37 males, 13 females, average age 18.5 years). There were 26 grade 1 and 24 grade 2 injuries. In the study group, 28 subjects received focal compression with an average of 3.04 days until full return (SD = 1.6). In the control group, 22 subjects received generalized compression with an average of 3.18 days for return (SD = 1.74). There was no statistical difference between the 2 treatment groups in return to activity (p = 0.759). Conclusions Focal compression, a more expensive intervention, provides no added benefit in time to return to activity compared to generalized compression. Continued use of generalized compression provides adequate and cost effective therapy. Grant funding for this study was provided by the Uniformed Services University of Health Sciences.

Protective distal finger splint

The purpose of this splint is to protect the distal aspect of a painful or sensitive finger using closed-cell padding with a rigid outer surface. This splint idea originated when a construction worker with a partial right-middle-finger amputation developed a painful neuroma. Surgery for revision was scheduled for one week. In the interim, the patient wanted some type of protection over the stump so that he could continue to work. Existing splints, such as a Stax finger splint or foam-padded aluminum splint, did not provide the protection the patient needed. The following materials are required for splint fabrication: 1/I6 Soft Micro Perforated Orfit (North Coast Medical, San Jose, California), 1/8 Rolyan Polycushion Padding (Smith and Nephew, Germantown, Wisconsin), and 1 Elastoplast elastic adhesive bandage (Beirsdorf, Canada) or Coban selfadherent elastic wrap (3M, St. Paul, Minnesota).

The Effects of Cryotherapy Applied through Various Barriers

The purpose of this study was to investigate the differences in skin temperature during ice application through a dry towel and a dry elastic bandage compared to application on bare skin. Nine subjects completed a 30-min treatment session that consisted of 0.68 kg of cubed ice applied under three conditions: through a dry towel, through a dry elastic bandage, and directly on the skin (control). Following the removal of the ice, all subjects were monitored for 20-min for skin temperature (S temp). There was a significant interaction in S temp between the control (12.50 ± 4.39 °C) and dry towel (23.48 ± 2.88 °C) conditions, the control (12.50 ± 4.39 °C) and dry elastic wrap (27.47 ± 2.36 °C) conditions, and the dry towel (23.48 ± 2.88 °C) and dry elastic wrap (27.47 ± 2.36 °C) conditions. The findings indicated that using a barrier (dry towel or dry elastic bandage) limits the temperature-reducing capacity of the ice and therefore its potential physiological effects.

Forearm muscle oxygenation decreases with low levels of voluntary contraction

The purpose of our investigation was to determine if the near infrared spectroscopy technique was sensitive to changes in tissue oxygenation at low levels of isometric contraction in the extensor carpi radialis brevis muscle. Nine subjects were seated with the right arm abducted to 45 degrees, elbow flexed to 85 degrees, forearm pronated 45 degrees, and wrist and forearm supported on an armrest throughout the protocol. Altered tissue oxygenation was measured noninvasively with near infrared spectroscopy. The near infrared spectroscopy probe was placed over the extensor carpi radialis brevis of the subject's right forearm and secured with an elastic wrap. After 1 minute of baseline measurements taken with the muscle relaxed, four different loads were applied just proximal to the metacarpophalangeal joint such that the subjects isometrically contracted the extensor carpi radialis brevis at 5, 10, 15, and 50% of the maximum voluntary contraction for 1 minute each. A 3-minute recovery period followed each level of contraction. At the end of the protocol, with the probe still in place, a value for ischemic tissue oxygenation was obtained for each subject. This value was considered the physiological zero and hence 0% tissue oxygenation. Mean tissue oxygenation (+/-SE) decreased from resting baseline (100% tissue oxygenation) to 89 +/- 4, 81 +/- 8, 78 +/- 8, and 47 +/- 8% at 5, 10, 15, and 50% of the maximum voluntary contraction, respectively. Tissue oxygenation levels at 10, 15, and 50% of the maximum voluntary contraction were significantly lower (p < 0.05) than the baseline value. Our results indicate that tissue oxygenation significantly decreases during brief, low levels of static muscle contraction and that near infrared spectroscopy is a sensitive technique for detecting deoxygenation noninvasively at low levels of forearm muscle contraction. Our findings have important implications in occupational medicine because oxygen depletion induced by low levels of muscle contraction may be directly linked to muscle fatigue.

In Vivo Tissue Temperature Comparison of Cryotherapy With and Without External Compression

Study objective: To compare the tissue-cooling efficiency of external cryotherapy with and without adjunctive compression. Methods: We conducted an experimental repeated-measures study in which each of the 11 anesthetized subject dogs served as its own control. A chemical instant cold pack was applied to each subject's ventral thighs. One pack was held in position by gravity, and the other was compressed against the musculature with a tubular elastic wrap. Baseline and subsequent temperature measurements were taken every 10 minutes for 1 hour with the use of an IM temperature probe percutaneously inserted into each subject's hind legs. Results: IM temperatures were not significantly different at baseline and were coldest at 20 minutes; they increased slowly thereafter. The recorded temperature was lower under the compressed cold pack ( P=.003), and changes over time for both groups were also significant ( P=.005). The instantaneous temperature difference at 10, 30, 40, 50, and 60 minutes was also significant. Conclusion: Externally applied instant cold packs in a dog model caused local tissue hypothermia that peaked by 20 minutes, persisted for at least 1 hour, and was significantly augmented by adjunctive compression. Further research is needed to evaluate the clinical efficacy and safety of these interventions in the management of acute soft-tissue injuries. [Barlas D, Homan CS, Thode HC Jr: In vivo temperature comparison of cryotherapy with and without external compression. Ann Emerg Med October 1996;28:436-439.]

Fractures of the distal shaft of the fifth metatarsal. "Dancer's fracture".

We retrospectively reviewed the office records of the senior author--which include two national ballet companies--and identified 35 dancers who sustained distal shaft fractures of the fifth metatarsal. The usual fracture pattern is a spiral, oblique fracture starting distal-lateral and running proximal-medial. Treatment consisted of open reduction and internal fixation for 2 patients, closed reduction and percutaneus fixation for 2 patients, short leg weightbearing cast for 7 patients, and an elastic wrap and treatment of symptoms for 24 patients. Patients with marked displacement of the fracture underwent internal fixation early in the study period; but more recent treatment emphasized nonoperative means, even for displaced fractures. The average time to pain free walking was 6.1 weeks (range, 0 to 16); return to barre exercises, 11.6 weeks (range, 4 to 48); and return to performance, 19 weeks (range, 6 to 52). There was one delayed union (7 months) and one refracture (2 months) that subsequently healed. All patients returned to professional performance without limitation and no patient reported pain with performance at followup. Spiral fractures of the distal shaft of the fifth metatarsal are common injuries and can usually be treated nonoperatively for these high performance athletes without long-term functional sequelae.

Early Ankle Mobilization, Part I: The Immediate Effect on Acute, Lateral Ankle Sprains (A Randomized Clinical Trial)

A random clinical trial was performed to determine the immediate effects of early ankle mobilization on active duty military members with moderate and severe lateral ankle sprains. Sixty-four subjects were randomly allocated to one of three treatments: a plaster cast, an air-stirrup (Aircast Inc., Summit, New Jersey), or an elastic wrap. Each intervention lasted 2 weeks followed by 3 weeks of rehabilitation. Subjects who were allowed early mobilization returned to work and running significantly sooner than those placed in plaster casts (p = 0.029). Swelling (p = 0.009) and pain (p < 0.001) decreased while range of motion increased (p = 0.027) in the early mobilization groups. Between the mobilization groups, those in the elastic wrap performed as well as those in the air-stirrup.

The Effects of Intermittent Compression on Edema in Postacute Ankle sprains

The purpose of this study was to compare the effects of three treatment protocols on pitting edema in patients with first- and second-degree sprained ankles. Thirty subjects with postacute (greater than 24 hours postinjury) ankle sprains and pitting edema but not requiring cast immobilization were randomly assigned to an elastic wrap group (N = 10), an intermittent compression group (N = 10), or an elevated control group (N = 10). Pretreatment and posttreatment volumetric measurements of the subjects' ankles were obtained by the water displacement method. After the pretreatment measurement, the groups were treated for 30 minutes. All subjects' ankles were elevated by raising the foot section of an adjustable table to a 45 degrees angle during treatment. For the first treatment group, the intermittent compression device was set at 40-50 mm Hg, with a 60-second on time and a 15-second off time. For the second treatment group, an elastic wrap was applied from the heads of the metatarsals to 12.7 centimeters above the malleoli. Control group subjects received only the elevated position as their treatment. A three by two repeated measures ANOVA with a follow-up post hoc test revealed that the elevated control group subjects had the least amount of edema (p < .0006). The two compression protocols produced increased edema in the subjects' sprained ankles following treatment. In conclusion, elevation is the most appropriate of the three treatment protocols if the major therapeutic objective is to minimize edema in the postacute phase of rehabilitation. J Orthop Sports Phys Ther 1991;14(2):65-69.

Effects of a proprietary topical medication on wound healing and collagen deposition in horses

Summary Full-thickness skin wounds were created on the dorsum of both metacarpi in 8 horses. Three topical treatment regimens were studied. All wounds were bandaged with a nonadherent dressing, which was held in place with a snug elastic wrap. Group-A wounds were treated with a proprietary topical wound medication that consisted of a spray and an ointment. Group-B wounds were treated with the same regimen, except the putative active ingredients in the ointment were omitted. Group-C wounds were treated with a dry nonadherent bandage only. Wound dressings were changed every day and the limbs were photographed every other day until the wounds were healed. Specimens of normal skin and biopsy specimens of healed wounds were examined histologically and were assayed for hydroxyproline content. Wound healing measurements quantitated for each wound were number of days to healing, maximal wound size attained, day wound contraction commenced, day epithelium first noticed, rate of wound contraction, final wound size, and fraction of the wound that healed by contraction. The cosmetic appearance of the healed wounds was also graded. Significant differences were not noticed in hydroxyproline content, histologic appearance, or any of the wound healing measurements between treatment groups. The cosmetic appearance of healed group-A and -B wounds was significantly better than the appearance of group-C wounds. The topical treatment regimens studied neither enhanced nor inhibited wound healing in this study.

Kasabach-Merritt syndrome: Treatment with epsilon-aminocaproic acid and assessment by indium 111 platelet scintigraphy

The association of a coagulopathy with hemangiomas is uncommon, occurring in less than 1 in 300 hemangiomas.l, 2 The coagulopathy may consist of isolated thrombocytopenia or may be accompanied by disseminated intravascular coagulation, an association originally described in 1940 by Kasabach and Merritt. 3 The morbidity and mortality rates corresponding to this syndrome are high. 4 Attempts at therapy have included corticosteroids, radiation, surgery, embolization, and anticoagulation, all with limited success.Z,5-9 Until recently, evaluation of therapeutic effects has been hindered by the lack of a noninvasive method to assess the degree of platelet entrapment within the h emangioma.10, 11 Therapeutic intervention and assessment of efficacy are further compromised in patients with multiple sites of hemangiomatous involvement or large sites with multiple vascular supplies. We describe a patient whose clinical course was complicated by major life-threatening hemorrhagic events, whose coagulopathy responded to an approach involving antifibrinolytic therapy, and whose course was followed by a new imaging technique that displays labeled platelet uptake within the tumor. CASE REPORT A large, cavernous hemangioma involving the left thigh and buttock, and extending across the midline to the right side of the perineum, developed in the patient in her first month of life. In the first 3 months of life she was treated with elastic bandage wrapping in an attempt to diminish the proliferation rate of the hemangioSupported by the Nuclear Medicine Research Fund of the Univer

The Effect of Elastic Compression on Tcpo2 in Limbs with Venous Stasis

A low oxygen tension might contribute to the dermatological changes produced by deep venous insufficiency and venous stasis. Since elastic support is often prescribed for stasis disorders, it would be of value to know whether compression alters the oxygen tension in affected skin. We performed studies in which the transcutaneous Po2 (TcPo2) was determined for the foot or lower leg in subjects with normal veins (n = 9) or with dermatitis caused by documented deep venous insufficiency (n = 14). Measurements were made using O2-sensing electrodes placed 1–2 cm apart; surface temperature was 45°C for one electrode (producing maximal vasodilation of the underlying skin) and 42°C for the other (producing submaximal vasodilation). The vasodilation index (VI = TcPo2 at 42 °C/TcPo2 at 45°C) was used as an index of vasomotor tone. In normal limbs, TcPo2 (mmHg) and VI were affected by the subject's posture (TcPo2 = 38.8 at 42°C and 61.4 at 45°C when supine; 40.8 at 42°C and 74.6 at 45°C when upright with legs dependent; VI = 0.63 supine and 0.53 upright). In limbs with venous stasis, TcPo2 and VI were considerably lower (TcPo2 = 23.6 at 42°C and 51.5 at 45°C when supine; 20.8 at 42°C and 60.5 at 45°C when upright; VI = 0.48 supine and 0.37 upright). Following the application of an elastic wrap to the limbs with stasis, upright values for TcPo2 and VI were substantially improved (TcPo2 with compression = 28.8 at 42°C and 62.4 at 45°C; VI = 0.46). We conclude that (1) TcPo2 is reduced in regions of skin affected by stasis dermatitis, and (2) elastic compression improves TcPo2 (during upright posture) in limbs with stasis dermatitis.

Treatment of Ankle Sprains With External Compression and Early Mobilization.

In brief: Edema associated with the inversion ankle sprain can be minimized by using a U- shaped compression pad held in place against the soft tissue around the fibular malleolus by an elastic wrap or tape. Control of edema allows earlier mobilization of the ankle joint, which reduces recovery time and permits the earliest possible return to sports participation. Factors to be considered in the construction of a compression pad include shaping, firmness, and conformability to the contours of the ankle and foot. Optimal results are obtained through continuous use of a U-shaped pad beneath an adjustable form of compression for as long as the potential for edema exists.

An in Situ Procedure for The Biopsy of Pressure-Wrapped Hypertrophic Scars

A plexiglass device can be incorporated in the therapeutic elastic wrapping of hypertrophic scars. The removal of a small access port on this device permits the exposure of the underlying tissue for full-thickness biopsy without the necessity of first removing the pressure wrapping. The ultrastructural detail of tissues biopsied in this manner more readily reflects the in situ microarchitecture of the pressure-wrapped skin and/or scars.