Hesperian Health Guides

Chapter 59: Correcting Joint Contractures

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HealthWiki > Disabled Village Children > Chapter 59: Correcting Joint Contractures


In this chapter we discuss different aids used for gradually straightening limbs that have joint contractures.

Information on contractures, their causes and prevention is in Chapter 8. Exercises to prevent and correct contractures are in Chapter 42.

Joint contractures can often be gradually straightened with casts or braces that gently but firmly hold the joint in a stretched position for a long time. We stress gently because unless great care is taken it is very easy to cause injuries.

To straighten a limb, 3 areas of pressure are needed. In theory, the leg could be straightened like this. In fact, this would cause pressure sores on the small areas where the splint presses.
1. 1.
Horizontal bent leg, arrows pointing.
Horizontal bent leg tied at the knee to board.
Horizontal bent leg with sores at knee, upper thigh and ankle.
2. 3. 2. 3. Also, the knee could be dislocated it the calf is not supported while stretching.
WRONG


Always use wide areas of pressure. Avoid pressure on the knee, behind the heel, and over bony areas.

BETTER Horizontal bent leg with cut tube shaped rectangles protecting upper thigh, knee and ankles tied to horizontal board.
well-padded pieces of cardboard tubes, plastic, plaster, or bamboo tight strap or band of car inner tube
If a child stays in bed, a stretching aid like one of these might work. (But try to keep the hip straight, so that the aid does not cause a hip contracture while it straightens the knee.)
child lying in bed with bent leg extended in the air with weight on top.
BETTER
weight here


There are several ways to straighten contractures that let the child continue to move about. These include:

1. a series of plaster casts 2. adjustable braces
Boy with leg in cast using crutches.
3 pictures of leg in cast that starts off bent and becomes progressively straighter.
3 types of adjustable braces.
3. elastic stretching aids of bamboo or inner tube 4. adhesive strapping
Open tube on an arm connected to wood strip that pulls to straighten bent hand.
Open tubes on bent upper and lower leg, connected to stick that pulls up lower leg. tape wrapped around the knee, calf and ankle of a child.


This page was updated:19 Jan 2018