Robert jones bandage

RE: Robert jones bandage

Evelyn Barbour-Hill — Wed, 03 Oct 2018 15:04:51 GMT

[quote user="Anthony Todd"]Just retains the bandage in position [could do the same with a RJ??].[/quote]

Ah. I've not found the need, yet.

RE: Robert jones bandage

Anthony Todd — Wed, 03 Oct 2018 12:58:00 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Anthony Todd"]You can retain the dressing by bandaging round the chest or pelvis, in a figure of 8,[/quote]

I can't really see why you'd want to do that for a dressing intended to support a fracture. Probably just my stupidity.

[/quote]

Just retains the bandage in position [could do the same with a RJ??].

RE: Robert jones bandage

Evelyn Barbour-Hill — Wed, 03 Oct 2018 11:45:21 GMT

[quote user="Anthony Todd"]Fair comment on your reply, except the above which applied not to the dressing but to the aluminium contoured rod or strip half way through the bandaging or on the outside and retained by sticking to the dressing itself.[/quote]

Oh, right, I see.

[quote user="Anthony Todd"]You can retain the dressing by bandaging round the chest or pelvis, in a figure of 8,[/quote]

I can't really see why you'd want to do that for a dressing intended to support a fracture. Probably just my stupidity.

[quote user="Anthony Todd"]Because the bandage is lighter and not weighted by heavy urine etc. it doesn't need much retention......[/quote]

Well, no dressing at all is immune from getting soaked in urine. If you'll forgive me an attempt at humour, a dressing that's soaked by urine doesn't need retention, it needs removal......

RE: Robert jones bandage

Anthony Todd — Wed, 03 Oct 2018 10:07:54 GMT

[quote user="Evelyn Barbour-Hill"]One thing I do dispute is that a "single circle of sticky stretchy plaster" could ever be relied upon to hold any dressing on.[/quote]

Fair comment on your reply, except the above which applied not to the dressing but to the aluminium contoured rod or strip half way through the bandaging or on the outside and retained by sticking to the dressing itself.

You can retain the dressing by bandaging round the chest or pelvis, in a figure of 8, watching for the penis if necessary.

Because the bandage is lighter and not weighted by heavy urine etc. it doesn't need much retention......

RE: Robert jones bandage

Evelyn Barbour-Hill — Tue, 02 Oct 2018 23:34:13 GMT

Anthony, i've done 'em all ways.The R-J, the aluminium splint as I called it which is what you describe , the gutter splint, the rolled-up newspaper (great in emergency), even the attempt at a Thomas splint which was favoured by one employer (unable to grasp that it was invented for the straight human leg rather than the angulated canine one), and my experienced opinion is that no single technique is ideal for every situation. For temporary immobilisation and comfort the R-J has its uses and so does the aluminium or the gutter splint. It depends on circumstances.

One thing I do dispute is that a "single circle of sticky stretchy plaster" could ever be relied upon to hold any dressing on. It may do. It may not. A properly applied R-J stays on by friction. A single strip of sticky plaster holds by sticking to a narrow strip of hair. Often it will hold long enough and sometimes it won't (I speak from experience). The stretchiness is irrelevant, as if you put it on stretched you risk it turning into a partial ligature.

Something else that needs saying over again is that you cannot immobilise a fracture from the stifle proximally, nor even one in the most proximal tibia, by an external dressing of any sort. However beautifully you may apply it up over the femur and however much satisfaction it gives you to look at it, it won't be doing any immobilising.

RE: Robert jones bandage

Liz Barton — Tue, 02 Oct 2018 23:14:27 GMT

[quote user="Anthony Todd"]PS ALWAYS leave the foot out; toes at least!![/quote]

I concur - always like to see the toes. If not, it's slipped!

[quote user="Anthony Todd"]Try what I have suggested and report back, good or bad.[/quote]

Fair point. What I have used has generally worked well for my patients, so I'd be reluctant to change (if it ain't broke... but that doesn't mean there isn't a better way). The only fractures I deal with are OOH for emergency stabilisation in a clinic with 24hr vet/nurse; obviously not the case for most practitioners on here!

As a general rule, the smaller or wigglier the patient, the lighter the bandage. I used cotton buds as a splint secured with micropore tape to stabilise on a minimally-displaced tibial/fibular fracture in a chihuahua puppy last week... any bandaging material AT ALL and it just slipped off.

RE: Robert jones bandage

Anthony Todd — Tue, 02 Oct 2018 22:52:26 GMT

[quote user="Julie Innes"]What is your viable alternative? . We've all explained why we're not keen on splints / casts (too rigid, cause sores, more likely to slip than a well-applied RJ) and stretchy bandage is great but gives no support! [/quote]

I'll try again with instructions... Wrap your # leg in soffban, one thickness, apply a stretchy bandage over this varying the pressure depending on fracture site and/or excess swelling.

If needed for stability shape an Al strip or wire as appropriate to retain the leg in the correct position elastic sticky plaster this in place top usually top and bottom only.

You can do the Al strip or wire half way through the bandaging giving you a light weight supported limb.

[quote user="Clare Tapsfield-Wright"]I always thought Robert Jones dressings worked because they were so cumbersome that the patient couldn’t be arsed to try and move in the kennel because they were cramped by a massive non bendy leg to deal with so it was easier to go to sleep. [/quote]

Indeed!!

[quote user="Liz Barton"]I don't use them in cats - in the acute setting to stabilise a similar fracture I tend to use a gutter splint with a lighter dressing of soffban and vetrap; less likely to slip and easier to remove quickly if they do slip.[/quote]

You make my case! A single circle of sticky stretchy plaster will hold it.

[quote user="Liz Barton"]Steady on Anthony! I think most of these comments are based on each clinician writing from their own reason and experience.[/quote]

They are, but nobody yet has said they have done what I do, just that they do or don't love RJs.....

BUT I think it sounds as if most of these experiences are based on animals in cages, in hospital, whereas I tried not to keep them in [hospitals were rare BITD, as was hospitalisation for fractures].

My descriptions are for temporary stabilisation prior to pin, cast or plate as a better lighter, easier, cheaper drier [!!] alternative to a RJ with an obvious advantage of pressure variation, both increase and decrease, cheapness and common sense.

Try what I have suggested and report back, good or bad.

PS ALWAYS leave the foot out; toes at least!!

RE: Robert jones bandage

Liz Barton — Tue, 02 Oct 2018 21:34:42 GMT

[quote user="Tim Browning"]

I am hoping someone can answer this as I have always wondered about them and never used them. I used to see lots of RJ applied that slipped down and did a lot of harm to high fractures and if a support really needed (not going there again) there are other bandaging techniques available.

The nurses had been trained to use them and loved them as a demonstration of nursing skill, would spend ages doing them and use a hell a lot of materials. Vets would ask for them at a drop of a hat, and not make a treatment plan or attempt some sort of assessment until x-ray, preferably when they were off shift!...

[/quote]

I've used them a lot in an OOH clinic for complex fractures, to provide stability, immobility and support. To place one properly in the acute situation you almost always need some sedation / strong analgesia, and I've always taken radiographs at the same time (if the dog is still enough for placing a decent RJ, it's also still enough for X-rays!).

In this situation, the dog is hospitalised for analgesia anyway, so has a vet/nurse monitoring it throughout the night. Rarely have I had any bandage slip if pain is well controlled; the animal tends to stay still unless on a supervised toilet walk.

I don't use them in cats - in the acute setting to stabilise a similar fracture I tend to use a gutter splint with a lighter dressing of soffban and vetrap; less likely to slip and easier to remove quickly if they do slip.

[quote user="Anthony Todd"]I would be totally happy and conceed gracefully if someone posted any reasoned comments but, again, we just have entrenched opinion, not based on any experience at all, of a viable sensible proven alternative.[/quote]

Steady on Anthony! I think most of these comments are based on each clinician writing from their own reason and experience.

RE: Robert jones bandage

Clare Tapsfield-Wright — Tue, 02 Oct 2018 18:48:47 GMT

I always thought Robert Jones dressings worked because they were so cumbersome that the patient couldn’t be arsed to try and move in the kennel because they were cramped by a massive non bendy leg to deal with so it was easier to go to sleep.

RE: Robert jones bandage

Julie Innes — Tue, 02 Oct 2018 18:28:17 GMT

What is your viable alternative? . We've all explained why we're not keen on splints / casts (too rigid, cause sores, more likely to slip than a well-applied RJ) and stretchy bandage is great but gives no support! I'm not really very sure why you think we are all sheep-like agreeing, in fact, when I first answered this thread I was sure I would be shot down for supporting (geddit?) the old fashioned RJ. I think for comfort an RJ would beat other forms of support (when used appropriately) hands down.

RE: Robert jones bandage

Anthony Todd — Tue, 02 Oct 2018 16:34:52 GMT

[quote user="David Mills"]The RJB despite its age plays a very important part in veterinary medicine, in part because it does actually cause immobilisation of the limb in our patients. [/quote]

As often on vetsurgeon.org entrenched dogma is hardly ever supported by any comparative evidence only entrenched opinion.

I won't give you the obvious example, yet this is another one.

I would be totally happy and conceed gracefully if someone posted any reasoned comments but, again, we just have entrenched opinion, not based on any experience at all, of a viable sensible proven alternative.

RE: Robert jones bandage

Evelyn Barbour-Hill — Mon, 01 Oct 2018 23:30:26 GMT

[quote user="Anthony Todd"]Sh1t, I knew I should have checked.................. sounded good though, and made the point??[/quote]

I'm quite aware that the Crimean War was over by 1857 (just as well, because we rather needed troops in India then ) but you didn't need to alter my words.

Anyway, Sir Robert Jones invented the RJ bandage during the Great War. The point of my telling you this is that it was devised as a means of temporarily immobilising a fracture and preserving the limb from further harm while the casualty was evacuated from the Field Dressing Station. The key word is "temporarily".

RE: Robert jones bandage

David Mills — Mon, 01 Oct 2018 22:49:07 GMT

[quote user="James Dunne"]I do use RJ bandages. They are useful for immobilisation of a fractured limb, which can help to reduce the pain of motion of over-riding fracture fragments, [/quote]

[quote user="James Dunne"]Bandages slipping tends to be a failure in their application rather than a fault of the bandage themselves[/quote]

These are the pertinent points.

We've been here before with RJBs but when applied properly (a single wrap of cotton wool) they can provide sufficient compression and support in the short term to allow an easier fracture repair 24-48h later.

Talk of stretchy bandages and the like is naive. There is quite a science to bandaging if you care you look even in a cursory fashion.

The RJB despite its age plays a very important part in veterinary medicine, in part because it does actually cause immobilisation of the limb in our patients.

RE: Robert jones bandage

James Dunne — Mon, 01 Oct 2018 21:59:20 GMT

Hi Anthony

I do use RJ bandages. They are useful for immobilisation of a fractured limb, which can help to reduce the pain of motion of over-riding fracture fragments, particularly if a patient bumps their leg into something while confined or transported. Fractures in the proximal thoracic limb can be immobilised by an 'around-the-thorax' bandage and extending it distally to the foot. Bandages slipping tends to be a failure in their application rather than a fault of the bandage themselves. I still use cotton wool for any medium or large-sized dog; to provide the 'cushion' needed you'd be forever and a day applying Sofban or similar. Like anything we do, there are indications and contra-indications for these devices and usually the problems they cause are in situations where they are inappropriate.

RE: Robert jones bandage

Anthony Todd — Mon, 01 Oct 2018 18:40:57 GMT

[quote user="Evelyn Barbour-Hill"]

Um, not sure if cotton wool as we know it was available just after the Crimean War, but I'm certain that Sir Robert Jones wasn't born until 1857.

[/quote]

Sh1t, I knew I should have checked.................. sounded good though, and made the point??

RE: Robert jones bandage

Evelyn Barbour-Hill — Mon, 01 Oct 2018 18:23:36 GMT

[quote user="Anthony Todd"]The springy compressive action of fluffy cotton-wool was the only option in the Crimean war,[/quote]

Um, not sure if cotton wool as we know it was available in the Crimean War, but I'm certain that Sir Robert Jones wasn't born until 1857.

RE: Robert jones bandage

Anthony Todd — Mon, 01 Oct 2018 16:19:25 GMT

[quote user="Julie Innes"]seem to get sores with casts[/quote]

I was referring to "temporary" bandages prior to surgery or casting, not casts per se.

The other advantage I found was when surgery was necessary the limb was roughly the same size as before the incident and not all oedamatous which made surgery so much easier.

RE: Robert jones bandage

Julie Innes — Mon, 01 Oct 2018 12:28:34 GMT

I like a good RJ . often use them instead of a cast etc in greyhounds (who always seem to get sores with casts, and whose owners rarely want to discuss any surgical options/ are a charity with limited funds). I've never had any urine soaked ones, but then I do check them regularly and get owners to come back at the first sign of moisture.

RE: Robert jones bandage

Tim Browning — Mon, 01 Oct 2018 09:29:39 GMT

RE: Robert jones bandage

Anthony Todd — Mon, 01 Oct 2018 09:08:18 GMT

Sorry about the formatting, it's not me guv!