Velpeau Bandage in Shoulder Luxation
Utilizing the Velpeau Sling for Traumatic Shoulder Luxation in Veterinary Practice
Traumatic shoulder luxation in veterinary patients is an infrequent occurrence, commonly attributed to trauma or vehicular accidents. These luxations can manifest in various directions, with medial and lateral being the most prevalent, while cranial and caudal luxations remain rare.
Diagnostic Evaluation:
Traumatic medial luxations present similarly to congenital cases. Lateral luxations are common in large-breed dogs following trauma, and cranial and caudal luxations are unequivocally due to traumatic incidents. Palpable misalignment between the acromion and the greater tubercle is often noticeable, facilitated by radiographic assessment.
Treatment Approach:
Traumatic medial shoulder luxations can often be managed conservatively by promptly reducing and stabilizing the luxated joint using a Velpeau sling. Sustained immobilization in the sling for a minimum of 2 weeks should be complemented by subsequent controlled leash walks for 2 to 4 weeks.
Lateral luxations can also be treated conservatively following reduction. However, a neutral sling or spica splint is advised to avert adduction of the shoulder seen with the Velpeau sling. Cranial and caudal luxations may benefit from immobilization in a spica splint if promptly addressed.
Post-Immobilization Rehabilitation:
After the immobilization phase, it is recommended to gradually reintegrate the animal to normal activity through controlled exercise and rehabilitation exercises over 2 to 6 weeks. This duration depends on the severity of the injury, as well as owner and patient compliance.
Technique to apply a Velpeau bandage in a step-by-step list:
Patient Positioning: Begin with the patient in an alert and standing position. Alternatively, if necessary, position the patient in lateral recumbency.
Carpal Flexion: Gently flex the carpal joint to a moderate degree.
Cast Padding Placement: Encircle the carpus and paw with cast padding, ensuring even distribution.
Joint Flexion Maintenance: While applying the cast padding around the torso, ensure constant flexion at the carpal, elbow, and shoulder joints. This step is crucial for proper immobilization.
Torso Encasement: Wrap the cast padding around the torso, encompassing the entire flexed forelimb. Maintain the alternating pattern of wrapping, moving caudally and cranially around the torso, while avoiding excessive compression.
Gauze Overlay: Overlay the cast padding with gauze, following the same caudal-to-cranial wrapping pattern.
Elastic Tape Application: Apply elastic tape over the gauze, using the same wrapping pattern, ensuring a secure yet not overly tight application.
Avoid Compression: Throughout the application, take care to prevent compression of the patient's thorax or the flexed carpus. Excessive compression can lead to discomfort and vascular obstruction.
Window for Assessment: Optionally, cut a small window into the lateral surface of the bandage to facilitate assessment of the toes and foot.
By following this step-by-step technique, you can effectively apply a Velpeau bandage, ensuring proper immobilization and patient comfort. Remember to adapt the procedure as needed based on the patient's condition and requirements.
REFERENCES:
TOBIAS, KM. Veterinary Surgery Small Animal. Elsevier. 2012.
