TY - JOUR
T1 - Improving clinical examination in acute tibial fractures by enhancing visula cues
T2 - The case for always 'cutting back' a tibial back-slab and marking the dorsalis pedis pulse
AU - Thomas, Alasdair
AU - Kimber, Cheryl
AU - Bramwell, Donald
AU - Jaarsma, Ruurd
PY - 2016/8/1
Y1 - 2016/8/1
N2 - Look, feel, move is a simple and widely taught sequence to be followed when undertaking a clinical examination in orthopaedics (Maher et al., 1994; McRae, 1999; Solomon et al., 2010). The splinting of an acute tibial fracture with a posterior back-slab is also common practice; with the most commonly taught design involving covering the dorsum of the foot with bandaging (Charnley, 1950; Maher et al., 1994; McRae, 1989). We investigated the effect of the visual cues provided by exposing the dorsum of the foot and marking the dorsalis pedis pulse. We used a clinical simulation in which we compared the quality of the recorded clinical examination undertaken by 30 nurses. The nurses were randomly assigned to assess a patient with either a traditional back-slab or one in which the dorsal bandaging had been cut back and the dorsalis pedis pulse marked. We found that the quality of the recorded clinical examination was significantly better in the cut-back group. Previous studies have shown that the cut-back would not alter the effectiveness of the back-slab as a splint (Zagorski et al., 1993). We conclude that all tibial back-slabs should have the bandaging on the dorsum of the foot cut back and the location of the dorsalis pedis pulse marked. This simple adaptation will improve the subsequent clinical examinations undertaken and recorded without reducing the back-slab's effectiveness as a splint.
AB - Look, feel, move is a simple and widely taught sequence to be followed when undertaking a clinical examination in orthopaedics (Maher et al., 1994; McRae, 1999; Solomon et al., 2010). The splinting of an acute tibial fracture with a posterior back-slab is also common practice; with the most commonly taught design involving covering the dorsum of the foot with bandaging (Charnley, 1950; Maher et al., 1994; McRae, 1989). We investigated the effect of the visual cues provided by exposing the dorsum of the foot and marking the dorsalis pedis pulse. We used a clinical simulation in which we compared the quality of the recorded clinical examination undertaken by 30 nurses. The nurses were randomly assigned to assess a patient with either a traditional back-slab or one in which the dorsal bandaging had been cut back and the dorsalis pedis pulse marked. We found that the quality of the recorded clinical examination was significantly better in the cut-back group. Previous studies have shown that the cut-back would not alter the effectiveness of the back-slab as a splint (Zagorski et al., 1993). We conclude that all tibial back-slabs should have the bandaging on the dorsum of the foot cut back and the location of the dorsalis pedis pulse marked. This simple adaptation will improve the subsequent clinical examinations undertaken and recorded without reducing the back-slab's effectiveness as a splint.
KW - Backslab
KW - Clinical examination
KW - Compartment syndrome
KW - Dorsalis pedis pulse
KW - Splint
KW - Tibial fracture
KW - Visual cues
UR - http://www.scopus.com/inward/record.url?scp=84969745180&partnerID=8YFLogxK
U2 - 10.1016/j.ijotn.2015.11.002
DO - 10.1016/j.ijotn.2015.11.002
M3 - Article
VL - 22
SP - 36
EP - 43
JO - International Journal of Orthopaedic and Trauma Nursing
JF - International Journal of Orthopaedic and Trauma Nursing
SN - 1878-1241
ER -