Contractures. A historical perspective.

Orthopedic history vividly documents the continuing battle between restoring tissue stability and preserving functional mobility. Prolonged and uninterrupted rest, popularized by Hilton and Thomas, but promoted by many before them and subsequently continued by Jones, Orr, and others, assures healing. Contractures that permanently limit function are not an uncommon consequence. Hippocrates, Hunter, Lucas-Championniere, and David advocated judicious motion. Timing and the interpretation of the patient's pathologic state have proved to be the critical criteria. Modern antibiotics, antiinflammatory medications, acute surgical repair, and techniques that combine stability and early motion provide today's orthopedic surgeons' great versatility and capability. Despite these advantages the threat of contractures remains. The dictum "rest until healed" persists. Physiologic posturing of inflamed or swollen joints to minimize tissue strain introduces resting positions of 15 degrees plantar flexion at the ankle, and 30 degrees flexion at the knee and hip. These will be perpetuated by contractures if not actively counteracted by timely mobilizing procedures. Each of these joint positions is a serious deterrent to walking without stressful substitutive posturing, and the patient's ability to function is impaired.