Immobilization

Immobilization refers to the process of holding a joint or bone in place witha splint, cast, or brace. This is done to prevent an injured area from moving while it heals.

When an arm, hand, leg, or foot requires immobilization, the cast, splint, orbrace will generally extend from the joint above the injury to the joint below the injury. For example, an injury to the mid-calf requires immobilizationfrom the knee to the ankle and foot. Injuries of the hip and upper thigh orshoulder and upper arm require a cast that encircles the body and extends down the injured leg or arm.

Casts are generally used for immobilization of a broken bone. Once the doctormakes sure the two broken ends of the bone are aligned, a cast is put on tokeep them in place until they rejoin through natural healing. Casts are applied by a physician, a nurse, or an assistant. They are custom-made to fit eachperson, 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 castsuse Gortex 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, 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 immobilizean injured arm or leg immediately after an injury. Before moving a person whohas injured an arm or leg some type of temporary splint should be applied toprevent further injury to the area. Splints may be made of acrylic, polyethylene foam, plaster, or aluminum. In an emergency, a splint can be made from apiece 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 isplaced 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.

Both braces and splints offer less support and protection than a cast and maynot be a treatment option in all circumstances.

A collar is generally used for neck injuries. A soft collar can relieve painby restricting movement of the head and neck. Collars also transfer some of the weight of the head from the neck to the chest. Stiff collars are generallyused to support the neck when there has been a fracture in one of the bonesof 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 astwo bones) and hold them in the correct position. For example, if the bone inthe 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 bonyprominence attached by a horse shoe shaped bow and rope to a pulley and weights suspended over the end of the patient's bed.

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 withelevation will reduce pain and speed the healing process by minimizing swelling.

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 longperiods of bed rest. Lying in one position in bed for an extended period of time can result in sores on the skin and skin infection. Long periods of bed rest can also cause a build up of fluid in the lungs or pneumonia. Urinarytract infections can result from extended bed rest.

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 canresult 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.

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