SKILL 56: Modified Robert Jones

1. Ensure that the limb is clean and dry.
2. Apply a primary layer to the surgical incision. This is a dressing appropriate for the wound if present.
3. Apply 2 tape stirrups of non-elastic adhesive tape, one laterally and one medially (but not covering the incision or primary layer).
4. Place your secondary layer by applying orthopaedic padding from distal to proximal evenly.
   • Always apply bandaging material from outward to inward and ensure that the material overlaps by 50% with each pass.
5. Ensure the distal aspects of toe 3 and 4 are visible. This enables checking the presence of moisture and the pressure of the bandage.
6. To hold the padding in place, follow the same principles to apply a conforming bandage layer.
7. Start your tertiary layer by applying your elastic cohesive bandaging in the same manner as your secondary layer– distal to proximal with a 50% overlap and evenly, using moderate tension.
8. Turn the stirrups up and stick down.
9. Apply a layer of self-cohesive bandage over at least the distal third of the bandage. This will help with avoiding external moisture contamination and general dirtiness. This layer can be replaced as necessary.

Note: If your stirrups are doing their job, you do not need to attach elastic tape/wrap to the patients’ skin at the top of the bandage.

Tips

• Put a tongue depressor or similar between the ‘free’ ends of the stirrups to help stop them from sticking to everything whilst you place the bandage.
• Small amounts of cotton can be placed between the toes to reduce rubbing and moist dermatitis.
• To check whether the bandage is too loose or tight; you should be able to just fit your little finger under the bandage at either end.
• If you have either applied too much bandage or the application was uneven, the bandaged limb will not look anatomically correct. Remove and reapply.
• These are temporary bandages; and are not designed to stay on for more than a day or two. Change as necessary, but remember, physical therapy on the affected limb is important for healing. Bandages can inhibit this, so should be removed as soon as possible to enable physical therapy to begin.