Immobilization

IMMOBILIZATION, or the creation of conditions of rest and immobility, has its greatest indications in relation to the organs of movement and the spine. I. has long been applied in fractures of the extremities, until its value was shaken by the opposite enthusiasm—mobilization. The great importance of I. in various inflammatory processes, especially in tuberculosis of bones and joints, is beyond doubt. Depending on the indications, absolute and prolonged I. or relative and short-term I. can be created. Absolute I. is usually created by a plaster cast and is particularly frequently applied in tuberculous lesions of joints. An essential condition for joint I. is the simultaneous fixation of two adjacent joints. Thus, in lesions of the hip joint, the knee joint is simultaneously immobilized. This is caused by the conditions of muscle attachment and their interaction on the joints. Relative, short-term I. is more often applied in fractures of bones (for example, fractura radii loco classico), when during the day the bandage is removed to perform physiotherapeutic manipulations. Relative I. is especially applicable in childhood, where the regenerative process occurs rapidly and there is no need for prolonged I. The means of immobilization are plaster casts, various types of splints, corsets, and apparatuses. In addition to the basic requirements for I. with plaster casts or splints (absence of strangulation, good modeling), one should always keep in mind the maintenance of the most advantageous position ('working position') for the given limb in case ankylosis or persistent contracture occurs as a consequence of I. Such a position for the shoulder joint will be abduction of the arm to 50°, for the elbow—flexion at an angle of 70°, for the hand—dorsal flexion (this is an essential condition); for the hip joint—slight abduction (10°), flexion, and very slight external rotation; for the knee joint—extension position or slight flexion (10-15°). For the ankle joint, the best position during I.—the foot at a right angle to the shin. In prolonged I., one should strive to maintain these positions of the limb. The immobilizing effect of apparatuses also has relative value and is indicated mainly in cases where the inflammatory process has subsided and is in the stage of resolution. On the contrary, where the inflammatory process is at its height, the apparatus does not achieve proper I. Plaster is an excellent and reliable means in this case. In addition to various bandages, splints, and apparatuses for I., there are also operative methods. Such is, for example, I. of a certain section of the spine by bone plastic surgery (Albee, Hibbs, and others). Such are the methods of extra-articular arthrodesis in tuberculosis of joints. It should be noted, however, that in relation to the spine, the immobilizing effect of the plaster bed is still without competition and in tuberculous spondylitis and in fractures of the spine. There are somewhat fewer indications for operative I. in fractures of bones, where immobilizing splints and bandages have not lost their value, especially for the upper extremity, for which rational immobilization is extremely important. It will be rational only in the case when, by creating conditions of rest for a particular joint, it does not limit the function of other joints and muscles. An example of irrational immobilization is the fixation of the wrist joint and the entire hand with the inevitable persistent contracture of the fingers. I., satisfying the biological requirements of rest in inflammatory processes, is often a negative factor for the joints of the extremities. The normal condition of joints is movement, in which all components of the joint are maintained in a physiological state. On the contrary, during prolonged I., the articular cartilage, synovial membrane, synovial fluid, and para-articular tissues undergo changes, which leads to persistent contractures and even ankylosis. This is a major drawback of I. as a method of treating various inflammatory diseases and traumatic injuries of the motor apparatus. Therefore, in opposition to I., methods based on early mobilization are proposed, especially in injuries of bones and joints. Skillful use of both means for immobilization and mobilizing methods depends on the experience, skill, and critical attitude of the physician toward pathological phenomena, taking into account the physiological features of the motor apparatus.