Compression Wrapping for Acute Closed Extremity Joint Injuries: A Systematic Review

Abstract

Objective Current prehospital recommendations for an acute closed extremity joint injury (ACEJI) are to apply compression in some manner. However, the effectiveness of compression is unclear. We performed a systematic review to summarize and synthesize the evidence for the use of a compression bandage for ACEJI in the prehospital setting. Data Sources Cochrane Library, PubMed, and Embase were searched for relevant literature in November 2019. Study Selection Controlled trials involving adults in the prehospital setting with a recent ACEJI were included when compressive, nonimmobilizing interventions, feasible in a first aid setting, were applied and compared with no compression or any noncompressive intervention, such as braces, splints, or noncompressive stockings. Articles in all languages were included if an English abstract was available. Data Extraction Data on study design, study population, intervention, outcome measures, and methodologic quality were extracted from each included article. Data Synthesis Eight studies out of 1193 possibly relevant articles were included. All authors examined compression in the treatment of acute ankle sprains; no studies involved compression for the treatment of other ACEJIs. No difference in the major outcomes of pain reduction or swelling, ankle-joint function, or range of motion could be demonstrated. For the outcome of recovery time, no benefit was shown when comparing compression with no compression. Evidence was insufficient to inform a conclusion about the outcomes of time to return to work or sport. All evidence was of low to very low quality. Conclusions The evidence for the use of a compression wrap was limited to patients with closed ankle injuries. In this systematic review, we could not demonstrate either a beneficial or harmful effect from the application of a compression or elastic bandage compared with no compression or a noncompressive stocking, splint, or brace as a first aid treatment in the prehospital environment.

Executive Summary: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

“…The task force requested a SysRev to identify and analyse the evidence about treatment of these injuries. 138 The evidence, consisting of only in-hospital RCTs, found that compression wraps did not reduce pain 139,140 or swelling 139,141,142 or improve range of motion. 139À141, 143,144 One small randomized trial found that a compression wrap did reduce recovery time and shorten time to return to sports.…”

Executive Summary 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

“…The task force requested a SysRev to identify and analyse the evidence about treatment of these injuries. 138 The evidence, consisting of only in-hospital RCTs, found that compression wraps did not reduce pain 139 , 140 or swelling 139 , 141 , 142 or improve range of motion. 139 , 140 , 141 , 143 , 144 One small randomized trial found that a compression wrap did reduce recovery time and shorten time to return to sports.…”

First aid

“…1 8 Infografik Erste Hilfe [4,5]. Einige der systematischen Überprüfungen wurden direkt veröffentlicht, darunter "Sofortmaßnahmen bei Präsynkope" [7], "Behandlung von Hypoglykämie" [8], "Frühe versus späte Gabe von Acetylsalicylsäure bei Brustschmerzen nichttraumatischer Genese" [9], "Kühltechniken bei Hitzschlag und anstrengungsbedingter Hyperthermie" [10], "Kompressionsverband bei akuten, geschlossenen Gelenksverletzungen" [11], "Zahnverlust" [12] und "Erkennen eines Schlaganfalls durch Ersthelfer" [13].…”

“…Für Eine neue systematische Überprüfung für 2020 wurde von der ILCOR Arbeitsgruppe für Erste-Hilfe durchgeführt, in der die am besten verfügbaren Belege für die Verwendung eines Kom-pressionsverbands zur Behandlung von geschlossenen Gelenkverletzungen an den Extremitäten überprüft wurden [4,5]. Insgesamt wurden 1193 Referenzen identifiziert, von denen schließlich sechs randomisierte, kontrollierte Studien [239,[242][243][244][245][246] und zwei nichtrandomisierte, kontrollierte Versuche [247,248] [4,5,11]. Darüber hinaus konnte die Task Force aufgrund fehlender Evidenzen keine Empfehlung für oder gegen die Verwendung eines Kompressionsverbands für andere geschlossene Verletzungen von Gelenken, abgesehen von Knöchelverletzungen, empfehlen.…”

“…Die Task Force stellte fest, dass alle Studien in Krankenhäusern durchgeführt wurden und keine von außerhalb stammten. Sie stellte ebenfalls fest, dass möglicherweise eine spezielle Schulung erforderlich ist, um einen Kompressionsverband sicher und effektiv an einem verletzten Gelenk anbringen zu können [4,5,11]. Reponieren Sie die fehlgestellte Fraktur nicht gerade aus, sondern fixieren Sie sie in der Position, in der Sie mit möglichst wenig Bewegungen die Schiene anbringen können (Good Practice Statement).…”