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Immobilization refers to the process of holding a joint or bone in place with a splint, cast, or brace. This is done to prevent an injured area from moving while it heals.
Splints, casts, and braces support and protect broken bones, dislocated joints, and such injured soft tissue as tendons and ligaments. Immobilization restricts motion to allow the injured area to heal. It can help reduce pain, swelling, and muscle spasm. In some cases, splints and casts are applied after surgical procedures that repair bones, tendons, or ligaments. This allows for protection and proper alignment early in the healing phase.
There are no special precautions for immobilization.
When an arm, hand, leg, or foot requires immobilization, the cast, splint, or brace will generally extend from the joint above the injury to the joint below the injury. For example, an injury to the midcalf requires immobilization from the knee to the ankle and foot. Injuries of the hip and upper thigh or shoulder and upper arm require a cast that encircles the body and extends down the injured leg or arm.
Casts and splints
Casts are generally used for immobilization of a broken bone. Once the doctor makes sure the two broken ends of the bone are aligned, a cast is put on to keep them in place until they are rejoined through natural healing. Casts are applied by a physician, a nurse, or an assistant. They are custom-made to fit each person, and are usually made of plaster or fiberglass. Fiberglass weighs less than plaster, is more durable, and allows the skin more adequate airflow than plaster. A layer of cotton or synthetic padding is first wrapped around the skin to cover the injured area and protect the skin. The plaster or fiberglass is then applied over this.
Most casts should not be gotten wet. However, some types of fiberglass casts use Gore-tex padding that is waterproof and allows the person to completely immerse the cast in water when taking a shower or bath. There are some circumstances when this type of cast material can not be used.
A splint is often used to immobilize a dislocated joint while it heals. Splints are also often used for finger injuries, such as fractures or baseball finger. Baseball finger is an injury in which the tendon at the
end of the finger is separated from the bone as a result of trauma. Splinting also is used to immobilize an injured arm or leg immediately after an injury. Before moving a person who has injured an arm or leg some type of temporary splint should be applied to prevent further injury to the area. Splints may be made of acrylic, polyethylene foam, plaster of paris, or aluminum. In an emergency, a splint can be made from a piece of wood or rolled magazine.
Slings are often used to support the arm after a fracture or other injury. They are generally used along with a cast or splint, but sometimes are used alone as a means of immobilization. They can be used in an emergency to immobilize the arm until the person can be seen by a doctor. A triangular bandage is placed under the injured arm and then tied around the neck.
Braces are used to support, align, or hold a body part in the correct position. Braces are sometimes used after a surgical procedure is performed on an arm or leg. They can also be used for an injury. Since some braces can be easily taken off and put back on, they are often used when the person must have physical therapy or exercise the limb during the healing process. Many braces can also be adjusted to allow for a certain amount of movement.
Braces can be custom-made, or a ready-made brace can be used. The off-the-shelf braces are made in a variety of shapes and sizes. They generally have Velcro straps that make the brace easy to adjust, and to put on and take off. Both braces and splints offer less support and protection than a cast and may not be a treatment option in all circumstances.
A collar is generally used for neck injuries. A soft collar can relieve pain by restricting movement of the head and neck. They also transfer some of the weight of the head from the neck to the chest. Stiff collars are generally used to support the neck when there has been a fracture in one of the bones of the neck. Cervical collars are widely used by emergency personnel at the scene of injuries when there is a potential neck or head injury.
Immobilization may also be secured by traction. Traction involves using a method for applying tension to correct the alignment of two structures (such as two bones) and hold them in the correct position. For example, if the bone in the thigh breaks, the broken ends may have a tendency to overlap. Use of traction will hold them in the correct position for healing to occur. The strongest form of traction involves inserting a stainless steel pin through a bony prominence attached by a horseshoe-shaped bow and rope to a pulley and weights suspended over the end of the patient's bed.
Traction must be balanced by countertraction. This is obtained by tilting the bed and allowing the patient's body to act as a counterweight. Another technique involves applying weights pulling in the opposite direction.
Traction for neck injuries may be in the form of a leather or cotton cloth halter placed around the chin and lower back of the head. For very severe neck injuries that require maximum traction, tongs that resemble ice tongs are inserted into small holes drilled in the outer skull.
All traction requires careful observation and adjustment by doctors and nurses to maintain proper balance and alignment of the traction with free suspension of the weights.
Immobilization can also be secured by a form of traction called skin traction. This is a combination of a splint and traction that is applied to the arms or legs by strips of adhesive tape placed over the skin of the arm or leg. Adhesive strips, moleskin, or foam rubber traction strips are applied on the skin. This method is effective only if a moderate amount of traction is required.
There are many reasons for immobilization using splints, casts, and braces. Each person should understand his or her diagnosis clearly.
After a cast or splint has been put on, the injured arm or leg should be elevated for 24 to 72 hours. It is recommended that the person lie or sit with the injured arm or leg raised above the level of the heart. Rest combined with elevation will reduce pain and speed the healing process by minimizing swelling.
Fingers or toes can be exercised as much as can be tolerated after casting. This has been found to decrease swelling and prevent stiffness. If excessive swelling is noted, the application of ice to the splint or cast may be helpful.
After the cast, splint, or brace is removed, gradual exercise is usually performed to regain muscle strength and motion. The doctor may also recommend hydrotherapy, heat treatments, and other forms of physical therapy.
For some people, such as those in traction, immobilization will require long periods of bedrest. Lying in one position in bed for an extended period of time can result in sores on the skin (decubitus ulcers) and skin infection. Long periods of bedrest can also cause a buildup of fluid in the lungs or an infection in the lungs (pneumonia). Urinary infection can also be a result of extended bedrest.
People who have casts, splints, or braces on their arms or legs will generally spend several weeks not using the injured arm or leg. This lack of use can result in decreased muscle tone and shrinkage of the muscle (atrophy). Much of this loss can usually be regained, however, through rehabilitation after the injury has healed.
Immobility can also cause psychological stress. An individual restricted to a bed with a traction device may become frustrated and bored, and perhaps even depressed, irritable, and withdrawn.
There is the possibility of decreased circulation if the cast, splint, or brace fits too tightly. Excessive pressure over a nerve can cause irritation or possible damage if not corrected. If the cast, splint, or brace breaks or malfunctions, the healing process of the bone or soft tissue can be disrupted and lead to deformity.
Normally, the surgical or injured area heals appropriately with the help of immobilization. The form of immobilization can be discontinued, which is followed by an appropriate rehabilitation program under the supervision of a physical therapist to regain range of motion and strength.
Decubitus ulcers — A pressure sore resulting from ulceration of the skin occurring in persons confined to bed for long periods of time
Ligament — Ligaments are structures that hold bones together and prevent excessive movement of the joint. They are tough, fibrous bands of tissue.
Pneumonia — An acute or chronic disease characterized by inflammation of the lungs and caused by viruses, bacteria, or other microorganisms.
Tendon — Tendons are structures that attach bones to muscles and muscles to other muscles.
"Casts & Splints." The Center for Orthopaedics and Sports Medicine. http://www.arthroscopy.com.
the rendering of a part incapable of being moved.
The act of making immovable.
See also: immobilize.
See also: immobilize.
immobilizationThe avoidance of movement of an injured or diseased part, especially a bone fracture, so that healing may take place. Effective fracture immobilization demands that the joint above and below the fracture should be unable to flex. Immobilization is achieved by means of slings, splints, plaster of Paris casts, cold-setting plastic casts and external steel bar fixators of variable design.
immobilizationthe locking up of inorganic substances within organic compounds so that they are no longer available for circulation in the environment.
The act or process of fixing or rendering immobile.