1. Mechanical Immobilization
Karen Malt, MSN, RN

2. Mechanical Immobilization
Cause of physical immobility
Debilitating conditions
Traumatic Injury
Treatment for a traumatic injury (use of slings, casts, traction, external fixators).
Orthoses- Orthopedic devices which support or align a body part and prevent or correct deformities.
Splints
Immobilizers
Braces

3. Purposes of Mechanical Immobilization
Most clients who require mechanical immobilization have suffered trauma to the musculoskeletal system. These injuries require time to heal often resulting in inactivity to restore the damaged structures.
Mechanical Immobilization of a body part accomplishes:
Relief of pain
Supports and aligns skeletal injuries
Restricts movement while injuries heal
Maintains a functional position until healing is complete
Allows activity while restricting movement of an injured area
Prevents further structural damage and deformity.

4. Mechanical Immobilizing Devices
The use of various immobilizing devices can achieve therapeutic benefits.
Examples include;
Splints
Slings
Braces
Casts
Traction

5. Mechanical Immobilizing Devices
Splints- A device used to immobilize and protect an injured body part. Splints are used before or instead of casts or traction.
Emergency Splint- Applied as a First-aid measure for suspected sprains or fractures.
Commercial Splints- More effective than improvised splints. They are available in various designs depending on the injury. Examples include; inflatable splints, traction splints, (short term use) immobilizers, molded splints,(Long-term use) and cervical collars.
Inflatable Splints- also called “pneumatic splints” are immobilizing devices that become rigid when filled with air. In addition to limiting motion, they also control bleeding, and swelling. The injured body part is inserted into the deflated splint. When the air is infused, the splint molds to the contour of the injured part, preventing movement. These splints are used most often in first-aid. The injury should be examined and treated soon after the application of the splint.

6. Mechanical Immobilizing Devices
Traction Splints- metal devices that immobilize and pull on contracted muscles. They are not as easy to apply as inflatable splints. One example is a Thomas Splint, which requires special training on its application to prevent additional injuries. This type of splint may be used to suspend a leg in traction.
Immobilizers- Commercial splints made from cloth and foam and held in place by adjustable hook and loop tape such as Velcro straps. They are removed during brief periods such as for hygiene, and dressing.
Molded Splints- orthotic devices made of rigid materials and are used for chronic injuries accompanied by inflammation. These types of splints provide support and limit movement to prevent further damage. They also, maintain the body part in a functional position to prevent contractures and muscle atrophy during immobility. They may be used for clients with repetitive motion disorder such as
Carpal Tunnel
Plantar Fasciitis
Achilles tendonitis

7. Mechanical Immobilizing Devices
Cervical Collars- a foam or rigid splint placed around the neck. It is used to treat athletic neck injuries and other trauma that results in a neck sprain or strain.
Neck strain or sprain is sometimes referred to as “whiplash” or “whiplash injury.” Neck injuries are typically more painful the day after the trauma.
Whiplash has decreased primarily for two reasons:
Improved athletic protective equipment
Use of shoulder harnesses and neck supports in automobiles
When a neck injury is mild or moderate, a foam collar with a stockinette is used. For more serious injuries, a rigid splint made from polyurethane is used to control neck motion and support the head, reducing its load bearing force on the cervical spine.

8. Mechanical Immobilizing Devices
To determine the proper collar size’
Measure the neck circumference and the distance between the shoulder and the chin.
Compare the measurements with the size guide prepared by the manufacturer of the collar.
When applying a cervical collar the head is placed in a neutral position. The front of the collar is positioned well beneath the chin and slid upward until the chin is well supported. The opening of the collar is centered at the back of the neck. Straps are used to secure the collar in place.
Clients wear the collar almost continuously, typically for 10 days to two weeks. They are removed to do gentle ROM neck exercises. The sooner the client performs the exercises the sooner revascularization/recovery occur. Prolonged dependence on the collar can lead to permanent neck stiffness.

9. Mechanical Immobilizing Devices
During recovery of a neck injury, the nurse assesses the client’s neuromuscular status by having the client perform movements that correlate with muscular functions controlled by cervical spine and peripheral nerve roots. If neuromuscular function is intact, the client can do the following:
Elevate both shoulders
Flex and extend the elbows and wrists
Generate a strong hand grip
Spread fingers
Touch the thumb to the little finger on each hand.
NOTE: The nurse then will document and communicate this information to the physician any difference in strength or movement on one side or the other.

10. Mechanical Immobilizing Devices
Slings- A cloth device used to elevate, cradle, and support parts of the body. Slings are applied commonly to the arm, leg, or pelvis after immobilization and examination of the injury.
Most ambulatory clients used a commercially made arm sling, or a triangular cloth mesh can be used to form a sling. To be effective slings require proper application.

11. Mechanical Immobilizing Devices
Braces- custom made or custom fitted devices designed to support weakened structures.
Three categories of braces;
Prophylactic- Used to prevent or reduce the severity of a joint injury.
Functional – Provide stability for an unstable joint
Rehabilitative – allow motion of an injured joint that has been treated operatively.
Clients generally wear braces during active periods, braces are made of sturdy materials such as metal or leather. Leg braces may be incorporated into a shoe. Some back braces are made of cloth with metal staves, or strips sewn within the fabric of the brace.
NOTE: AN ill fitting brace can cause discomfort, deformity, and skin ulcerations from friction or prolonged pressure.

12. Mechanical Immobilizing Devices
Casts- a rigid mold placed around an injured body part after it has been restored to correct the anatomic alignment. Casts are formed using wetted rolls of plaster of Paris or pre- moistened rolls of fiberglass.
Purpose: Continuously immobilize the injured structure.
Casts are usually applied to fractured bones.

13. Mechanical Immobilizing Devices
Types of Casts –
Cylinder Cast – The most common type. Encircles an arm or leg and leaves the toes or fingers exposed. The cast extends from the joint above and below the affected bone. This prevents movement in the injured area, thereby maintaining correct alignment during healing. As healing progresses, the cast may be trimmed or shortened.
Body Cast – The largest form of a cylinder cast and encircles the trunk of the body instead of an extremity. It generally extends from the nipple line to the hips. For some clients with spinal problems, the body cast extends from the back of the head and chin areas to the hips, with modifications for exposing the arms.
Bivalved Cast – A cast that is cut into two pieces lengthwise from either a body or a cylinder cast. A bivalve cast on an extremity is created when;
Swelling compresses tissue and interferes with circulation.
The client is being weaned from the cast.
A sharper X-Ray image is needed.
Painful joints need to be immobilized temporarily for a client with arthritis.

14. Mechanical Immobilizing Devices
Types of Casts – (continued);
Spica Cast – encircles one or both arms or legs and the chest or trunk. It may have an abduction bar to help maintain the position of the repaired injury.
When applied to the upper body; the cast is referred to as a shoulder spica. One applied to the lower extremities is a hip spica.
Spica Casts are; heavy, hot, cause frustration to the client due to severe restriction of movement.
NOTE: When applied to the lower extremities the spica cast is trimmed to the anal area to allow for elimination. Clients in a hip spica cannot sit during elimination, so the nurse protects the cast with plastic wrap and assists the client with a fracture bedpan.

15. Cast Application Generally requires more than one person. The nurse;
Prepares the client
Assembles the Equipment
Assists the physician during application
Note; A light cured fiberglass cast requires exposure to an ultraviolet light to harden the cast.

16. Cast Care
See Skill 25-3 Providing Basic Cast Care- page 577 Timby also see video provided.
Compartment Syndrome – As the nurse it is essential to assess the presence and quality of pain in the area covered by the cast, especially if it is unrelieved by elevation, cold applications and analgesic mediations. Unrelieved pain of increasing intensity suggests a complication known as “Compartment Syndrome.” Tis is caused by pressure due to swelling within the inelastic fascia that surrounds the muscles.

17. Cast Removal
Casts are most often removed when they need to be changed and reapplied, or when the injury has healed. A cast is removed prematurely if complications develop.
Most casts are removed with an electric cast cutter (an instrument that looks like a circular saw.) A cast cutter can cause anxiety with the client, but proper use leaves the skin intact. A physician is trained in proper cast cutting techniques, medical assistants, physician assistants are also qualified to perform cast cutting.
When the cast is removed it is normal to see the muscle has shrunk down due to inactivity and is weaker. The joints may have limited ROM. The skin may look pale and waxy and may contain dry, dead skin.

18. Traction
Traction is a pulling effect exerted on a part of the skeletal system. It is a treatment measure for musculoskeletal trauma and disorders. Traction is used to accomplish the following:
Reduce muscle spasms
Realign bones
Relieve pain
Prevent deformities
NOTE: the pull of the traction generally is offset by the counterpull from the client’s own body weight. EXCEPT for traction exerted with the hands, application of traction involves the use of weights connected to the client through a system of ropes, pulleys, slings, and other equipment.

19. Types of Traction Three Basic Types of Traction;
Manual- Means pulling on the body using a person’s hands and muscular strength. Most often used briefly to realign (set) a broken bone. Also, used to replace a dislocated bone into its original position.
Skin - A pulling effect on the skeletal system by applying devices to the skin, such as a pelvic belt and a cervical halter. Other names for commonly used skin traction is called “Buck’s Traction” and “Russells Traction.”
Skeletal – pull exerted directly on the skeletal system by attaching wires, pins, or togs into or through a bone. Skeletal traction is applied continuously for an extended period to the skull, humerus, and femur.
Traction Care- Regardless of the type of traction used, effectiveness depends on the application of certain principles during the client’s care. Review Principles for Maintaining Effective Traction (page 566 Timby).

20. External Fixators
A metal device inserted into and through one or more broken bones to stabilize fragments during healing. Although the external fixator immobilizes the area of injury, the client is encouraged to be active and mobile.
Pin Site Care – is performed by the nurse. The is essential to prevent infection. See figure Insertion of pins impairs skin integrity and provides a port of entry for pathogens.

21. Stop, Think, and Respond
A culture from a specimen taken at a pin site reveals that the pin site is infected with Staphylococcus Aureus. What nursing actions are required for contact precautions to control transmission of the pathogen?