This Issue's Rounds Question -
Please tell us: The term CREST is an acronym derived from the five most prominent features. What are they? (Question submitted by Lena Head, Nova Scotia) (responses to be published in next issue)

In the last issue of Body Cast, Rounds asked:What advice or tips would you give a patient wearing a figure of eight bandage for a fractured clavicle ?

The following answers were received:

From Desmond Brown:

There are five steps in teaching a patient how to use a figure of eight bandage:

Step 1: Wearing the figure of eight bandage should be done with the shoulder pressing back in an arch position, almost like a stretch.

Step 2: Adjustment of the splint through the day is crucial, as a figure of eight worn improperly can allow the fracture to heal improperly.

Step 3: Check circulation, making sure that the bace is not too tight. That would constrict the brachial artery causing symptomatic numbness, cold fingers and pain. Adjust brace if any symptoms arise.

Step 4: Check nerve impingement. With the figure of eight brace on too tight or improperly, impingement areas can arise causing numbness. Adjust brace to relieve any symptoms that arise, keeping in mind to keep brace snug, not too tight, in the proper position.

Step 5: If any concerns or problems, please contact your fracture clinic or nearest emergency.

From James Carragher and Lori MacDonald:

The clavicle or collarbone splint needs to be adjusted periodi­cally in order to allow proper healing of your broken collarbone.

If the splint loosens, a family member may tighten it on the back by pulling the straps until the shoulders are pulled back into good position, such as when you stand straight and tall.

During the night, a rolled up towel can be placed on the bed between your shoulder blades. This helps to keep your shoulder in proper position while asleep.
Do not shower; you may have a sponge bath or a tub bath (if someone can assist you). Do not raise your arms above your head.

From Mary Anne Christenson:

A figure of eight or clavicle splint is used for a clavicle frac­ture. Its purpose is to spread out the two shoulders and stretch apart the collarbone to allow it to fall into place. We tell our clients to leave it on continually, and tighten it up as needed to keep that straight posture. Make sure it is not too tight to cause any numbness or swelling. Take pain medication, and ice may be applied to injury, as needed. Pad any areas if rubbing or irri­tation occurs. We reassure that pain will subside, and healing takes place usually in six weeks.

From Derek Gauthier:

Clavicle fractures are very painful and uncomfortable. Even simple daily routines will become difficult. The figure of eight bandage is to remain constant, not to be taken off. The shoulders should be held back, doing the "superman" pose. Bandage should be worn against the skin under the clothes. Sponge baths are recommended. Reclining chair or lots of pillows to keep the patient in a sitting position for sleeping might be easier; laying flat on the back may prove difficult to get up. To get a shirt on, put the affected arm in first, followed by the head and opposite arm. Reverse routine to remove shirt. Sometimes, because of the tightness to the axillary area, fingers may become numb and tingly. Patient is to do the "superman" pose to try and relieve the pressure and restore normal sensation. If symptoms persist, patient can, with some assistance, loosen straps a little, as need­ed. Patient may require a sling for comfort, but is encouraged to remove sling for limited arm exercise and movement. Regular visits may be required to check skin integrity and brace fitting.

Answers were also received from: R. Aceron, L. Arseneau, M. Buchner, T. Bellon, A. Bradley, L. Burk, A. Carlos, J. Campbell, L. Chen, E. Christiansen, R. Chun, A. Crossman, J. Delsey, B. Doucet, D. Edwards, M. Florian, I. Fluerar, D. Gauthier, M. Gillingham, J. Gomez, R. Grenier, S. Groulx, E. Hayes, L. Head, L. Helfer, S. Hutchinson, S. Jankowski, B. Lavallee, B. Letourneau, C. Longphee, D. Longphee, L. Lough, G. Marshall, B. Matheson, J. Maulucci, A. Minoo, J. Movasseli, E. Muyot, E. Oborowsky, T. Odgen, R. Pagay, J. Pike, L. Pizzale, P. Power, P. Ritchie, C. Rivers, V Robichaud, E. Seguin, B. Sheppard, S. Shivpaul, V. Stockdale, A. Tarambikos, M. Unger, A. Wentzell, H. Wong, N. Yao, J. Yarnell, T. Yorke, and M. Young