The object of early passive movement in recent fractures is the very simple one of preventing adhesions, as opposed to the results of the older methods of absolute fixation of the limb, which of necessity leads to some matting together of the parts about the fracture, which, after union has taken place, frequently requires for its cure either prolonged passive movements or forcible breaking down under an anaesthetic ; in any event, whatever treatment is adopted for the rectification of the stiffness due to adhesions resulting from long-continued fixation, the disability of the patient is prolonged beyond all reasonable limits and in some cases becomes permanent. There is no doubt that in the many cases of fracture in which permanent disability follows upon faulty position of the fragments, the major part, and sometimes, indeed, all, of the disability is dependent upon adhesions of the parts around the fracture and not upon the bony deformity, unless this is great or of the rotatory kind. In any case of fracture after the fragments have been placed in accurate position passive movements should be commenced at once. In a fracture of the leg, for example, gentle movements of the toes may be made immediately with a view to making some to-and-fro motion of the muscles about the fracture (this is the so-called 'internal massage'); in fact, from the very beginning of a case treated on the lines under consideration the great object is to keep the muscles around the fracture continually on the move, which can be accomplished without any harmful movement of the bone fragments. Not only are adhesions thus prevented, but the circulation of the limb is stimulated and rapid union promoted. The earliest movements can be effected without the removal of splints, but in every case, as soon as the state of the fracture permits (i.e. from the third or fourth day onward), the splints should be loosened for gentle massage, by which the passive movement is not only rendered more easy, but also more effectual.

The main points in making passive movement in fractures which should be borne especially in mind are the following: (1) Steady fixation of the fracture itself should be insured, either by the grasp of the hand or by appropriate splints or apparatus. (2) All movements must be gently but deliberately made; the grasp of the parts by the manipulator's hand must be firm and unhesitating, although gentle - in this way a sense of certainty and confidence is imparted which generally removes any inclination to resistance on the part of the muscles.

If, however, as sometimes happens, there should arise between the hand of the manipulator and the muscles of the patient some involuntary antagonism (nearly always due to faulty handling of the parts), it can as a rule be obviated by practising the movements first on the sound limb, in order to give the muscles on the damaged side some idea of what is expected of them. The useful effect of this simple manoeuvre is well demonstrated in cases in which a normal joint has been kept still for some time in splints - e.g. the knee-joint in a case of fracture of the upper end of the leg treated by plaster of Paris. Upon the removal of the splint, if the patient be told to bend the joint he will generally at first be unable to do so, but in such cases, unless adhesions are present, if the attempts at movement are repeated after the movement has first been made on the sound side, normal action soon commences on the defective side, and is, as a rule, rapidly regained voluntarily.