Indications:

• Fractures of the 3rd to 5th finger and metacarpals.
• Dislocations of the 3rd to 5th fingers.
• Tendopathy.
• Tendon injuries.
• Soft tissue injuries.
• Positioning splint.
• Physio purposes.

The patient should be in a position which is comfortable to him/her and the person applying the bandage. This may vary depending on the extent of the injury, the diagnosis, the treatment method and the patient's condition.

Materials required: 1 x 5 cm Delta Cast Conformable polyester support bandage and hydrogel-coated casting gloves, toweling tubular bandage, adhesive bandage, 2 cm wide strip of X-ray film, bandage scissors, felt-tip pen.

Photo 1:
The toweling tubular bandage is pulled over the fingers, hand and wrist to form a layer of padding underneath. A strip of unusable X-ray film is inserted on the radial side to help with the cutting. To improve stability in specific areas (e.g. in repositioning a dislocated 5th metatarsal bone capitulum fracture) a 2 to 4 layer strip of cast is applied around the palm. This increases the bonding of the layers and produces a rigid dressing in this specific area.

Photo 2:
The cast is wrapped around the fingers, hand and wrist using circular movements (about 2 to 3 layers). The cast should be applied relatively tightly, extending it by 50% to 70%. This increases the bonding of the layers and improves the fit of the dressing. The cast should be applied to beyond the finger tips. This will simplify any later correction of the position of the joints. In the area of the previously applied longuette there are up to 6 to 7 layers of cast.

Photo 3:
During the molding phase of four to six minutes, corrections of the joint positions or the repositioning of a fracture can be carried out. Any folds in the dressing can be smoothed out by pulling the surplus cast at both ends lengthwise.

Photo 4:
After unrolling the cast bandage the cutting lines are marked with a felt-tip pen and the cast opened along the strip of X-ray film using bandage scissors. It is then trimmed for individual fit. In the case of stable fractures the cast can be removed to do this, with unstable fractures the cast should be left on the patient.

Photo 5:
The finished 3 finger hand cast including the wrist in an intrinsic position (radial view).

Photo 6:
The finished 3 finger hand cast including the wrist in an intrinsic position (ulnar view).

Photo 7:
The cast can be shortened at any time by trimming using bandage scissors. Finished ulnar 3 finger hand cast in an intrinsic position without inclusion, therefore allowing the wrist to function fully.

Photos 5, 6 and 7 show the same cast.
In photo 7 the cast was trimmed later. Both variations can put in place on the patient with an adhesive bandage. (Not shown here). The small number of layers means that the cast remains semi-flexible and can be adjusted depending on the individual state of the swelling (looser or tighter). To do this, the adhesive bandage is removed and the cast altered for a perfect fit.

Ulnar 3-finger cast without wrist inclusion: Here the proximal part of the cast gets cut with bandage scissors, so that the wrist retains its full function.

3-finger sandwich cast: The cast gets shortened proximaly, up to the finger base joints. This allows for an uninhibited movement of the wrist, as well as the fingers in their base joints.

Middle-hand cast: The cast gets shortened in the distal part up to the base or middle joints of the fingers. This allows for finger mobility.

All variants can get cut individually from the original cast, which got wound around all fingers !

The extent of the removal by cutting determines the grade of functionality or immobilization !