Indications:

• Fractures of the medial and proximal lower leg.
• Distal femur fractures.
• Tendon and ligament injury.
• 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: 3 x 10 cm and 1 x 7.5 cm Delta Cast Conformable polyester support bandage and hydrogel-coated casting gloves, toweling tubular bandage, Delta-Fix adhesive bandage, self-adhesive fleece padding, strapping, bandage scissors, felt-tip pen.

Photo 1:
The toweling tubular bandage is pulled over the leg to form a layer of padding underneath. A narrow strip of fleece padding is inserted beforehand to help with the cutting. U- or O-shaped fleece padding is used as additional padding for the ankle bones and fibula capitulum.

Photo 2:
To provide additional local padding a 2-layer longuette is prepared from the 7.5 cm cast bandage and applied on the outer side of the ankle joint and a 2-layer longuette (4 layers in the knee area) to the knee joint.

Photo 3:
2-3 layers of cast are wrapped around using circular movements. In the area of the previously applied longuettes, there are up to 4 to 7 layers of cast. This produces a stable cast in the rear area whilst retaining flexibility and therefore adjustability at the front. In order to achieve the best fit and bonding of the layers, the cast should be applied relatively tightly extending it by 50% to 70%. The cast is then molded for four to six minutes. Molding at the side of the femur condyles increases the comfort for the patient. Any folds in the cast in the thigh area can be easily smoothed out by pulling the proximal end lengthwise.

Photo 4:
Following the molding phase which takes approximately 4 to 6 minutes, the cutting lines are marked with the felt-tip pen and the cast is opened along the inserted fleece strip using bandage scissors. A notch is cut into the cast in the thigh area in order to prevent movement of the cut edges after re-application. Large areas of the cast are cut away in the areas of the patella and ankle joint. This simplifies the removal and re-application of the dressing.

Photo 5:
After trimming for individual fit, the fit of cast is checked on the patient and the cast is fixed in place with strapping taking into account the state of swelling. Velcro tape can be used as an alternative to strapping.

Photo 6:
An adhesive bandage is wrapped around the finished thigh cast. This makes the cast very stable and avoids the danger of fenestra edema in the areas of the knee and upper ankle joint.

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.

Tutor: Through cutting at the distal end the thigh cast can be changed into a tutor cast at any time. This allows for a consequent immobilization at the beginning of the therapy and a staged transition to functional treatment.
For example: Thigh cast Tutor Knee brace.