Immobilization, immobility (lat. Immobilis – “immovable”) is one of the medical procedures, which puts the body or limbs in a forced position or state of rest, in order to spare it, faster healing of wounds and reduce pain. Although it is one of the oldest medical procedures, as a form of caring for injured persons, the standard application of immobilization began only at the beginning of the 20th century.

Although the development of modern surgical techniques, aided by the discovery of antibiotics, led to significant changes in the approach to treating locomotor injuries using immobilization in the middle of the 20th century, conservative treatment is still inconceivable without immobilization as the primary and main method of treatment. Thus, in modern operative surgery, immobilization becomes an auxiliary method, which should ensure, improve and accelerate the success of surgical treatment.

Immobilization as a method in the 21st century is constantly supplemented with new approaches and aids, and the emergence of new (more sophisticated) means and materials enables classic immobilization procedures to be performed faster, simpler, cheaper and more acceptable to the patient.

Immobilization can be temporary, transport (to the place of application of appropriate treatment) or permanent (until healing). In the hospital treatment of bone fractures in the limbs, immobilization can be combined with extension.

Indications

The most common indications for immobilization are:

• All types and types of bone fractures
• Spinal and pelvic injuries
• Dislocations (luxation) of the joints
• Thermal limb injuries
• Tendon and peripheral nerve injuries
• Injuries to large blood vessels
• Severe injury to the soft tissues of the limbs
• All scapular and explosive wounds

Goals

Exemplary goals of immobilization are:

Prevent further pain

Prevention, das broken bone damages the integrity of the skin (ie not to turn from a closed fracture to an open one)

Further prevention of damage to nerves and / or large blood vessels (so that an uncomplicated one would not cause a complicated fracture)

Preservation of previously established hemostasis of small blood vessels

Preventing the spread of primary infection to the environment

Srvanje conditions for normal circulation by placing the body or limbs in a physiological position

Faster and more successful rehabilitation of injuries.

Principles

Immobilization of injuries to the spine, pelvis and larger bones is performed by several rescuers at the same time

The basic principles that must be strictly adhered to during immobilization are:

Mandatory, immobilization of at least two adjacent joints. Immobilization is well placed only if two adjacent joints become immobile.

To place the immobilized limb in a neutral (physiological) position (half-bent hand, elbow bent at an angle of about 75 degrees, knee half-bent, foot bent at right angles to the lower leg). If the injured limb is in a forced position, it is immobilized in such a position.

That soft parts of the body are protected (mainly with cotton wool, bandages or pieces of clothing). Immobilization splints are attached to the body with pendants made of triangular scarves, bandages or pieces of clothing, where the knots of the pendant are tied above the splint, and never above the unprotected parts of the limb.

That the damaged parts (wounds) must be protected with sterile gauze.

In case of bleeding, before applying immobilization, first apply a compression bandage.

To place the injured limb in an easily elevated position (in order to prevent swelling and ensure efficient circulation)

That the fingertips (of the immobilized limb) are always visible (due to the assessment of the neuro-vascular status lower than the place of injury).

Temporary immobilization

Vacuum mattress filled with air. The mattress is shaped around the patient. Then we pump out the air from the mattress, it becomes rigid

Trench collar, one of the standard means of immobilization intended to prevent the movement of the cervical vertebrae, in case of suspicion of physical trauma

Temporary immobilization is limited in time, and is most often applied at the place of injury and during the transport of the injured to the health institution where he will be given definitive treatment.

Depending on the location, type and severity of the injury and the means available at the site of the injury, immobilization may be performed using manual or standard means.

Immobilization by hand.

In the absence of factory equipment, hand tools are used at the site of injury, boards, triangular scarf, belt, and other items that can be found on the spot, the choice and method of placement depends on the resourcefulness of the person providing first aid.

The means chosen for immobilization should have a suitable shape, and appropriate strength and length. Immobilizers are covered with a soft cloth (cotton wool, bandage, parts of clothing,) or placed over the victim’s clothing or with previously placed soft cloth pads in the affected area.

Immobilization by standard means medical teams that provide emergency medical care to the injured are equipped with factory-produced splints-rails (Thomas, cameras, Dietrichs) made of easily flexible wire that is easy to model, collars and airbags for immobilization of limbs and spine. 

Transport immobilization

Definitive immobilization

Definitive immobilization is used as a basic therapeutic approach (eg in the treatment of fractures) or as an additional therapeutic approach (eg after repositioning a dislocated joint, injured soft tissue, joint structure), after tendon and nerve reconstruction) or after major soft tissue and skin reconstructions, so as not to jeopardize the results of the operation).

Definitive immobilization can be performed with plaster casts (alone or together with plastic materials) and traction-extension.

Plaster immobilization

Extensionore rescuers are immobilizing injuries to the spine, pelvis and larger bones.