Twist

Twist, one of the methods used in orthopedics for the conservative treatment of flexion contractures of neurological origin and inflammatory nature. The essence of this method, known since ancient times but first applied by Mommsen, consists in the application of small forces acting continuously and easily adjustable. The apparatus consists of plaster casts, wooden bars, cord, and a wooden stick, and for more complex and small joints other devices are also added. An example of applying a twist can be the most frequently used twist for knee joint contracture; it consists of two plaster casts, one of which is applied to the thigh and pelvis, and the other to the lower leg and foot in such a way that the knee joint remains free. A soft padding is placed on the anterior surface of the thigh, as this is where the wooden bar rests, extending upward along the axis of the limb. A hammock is placed under the plaster cast on the lower leg; a stick is bandaged transversely under the lower leg, the ends of which are connected with a double cord to the upper wooden bar. A small wooden stick is inserted between these cords, the turns of which slowly separate the two segments of the limb, which is in a state of contracture. Turns are performed daily; the number of turns depends on the appearance of pain. The first complaints of the patient force to stop twisting, sometimes stopping at half a turn. It is better to apply the twist in a hospital setting, as this method requires careful observation. When applying the twist, attention should be paid to good soft padding in those parts of the limbs where the greatest pressure develops when using the twist, which could cause the appearance of a bedsore. For padding, soft pillows, felt, and soft gutta-percha placed in a cover are used. The value of this method lies in the fact that the joint remains unirritated and the surrounding muscles do not atrophy due to continuous physiological work, so that after removing the cast the joint can be used. There are various modifications of the twist.