The mechanical treatment of compound and suppurating fractures occurring at the seat of war / by Robert Jones.

  • Robert Jones
Date:
1915
Catalogue details

Licence: Public Domain Mark

Credit: The mechanical treatment of compound and suppurating fractures occurring at the seat of war / by Robert Jones. Source: Wellcome Collection.

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    Fractures oF THE Lower Limp. Hip and Upper Thigh. Fractures through the hip-joint and those just below the trochanter are best treated by a modification of the Thomas splint, which I have described as an “abduction frame” (Fig. la). It is a splint upon which the patient lies and can be carried (Fig. 1 6). Extension is easily maintained and applied, and need not be relaxed for any purpose. The patient is placed upon this splint, and any displacement should be overcome by immediate extension in the abducted plane. ‘The limb should be rotated inwards slightly until the foot is at right angles to the tabie and be fixed in this position on the frame (Fig. 1 c). It will be seen by the illustration that both limbs are controlled and that extension is secured by strapping on the injured limb with counter extension by means of a smooth leather groin strap on the opposite side of the pelvis. This groin strap should not be slackened by the nurse under any pretext, but in order to avoid pressure sores she should be instructed to alter the area of skin over the adductors, which is subjected to pressure, by moving it to and fro. This method of ‘fixed extension” in abduction secures the lower limb in relation to the pelvis in a manner which can never be satisfactorily achieved by weight and pulley, where reliance is placed on the weight of the body for counter extension. It is by reflex nervous impulses, induced by changes of tension in the muscle, that muscular spasm is produced. A patient lying in bed with a fractured femur—high up or lower in the shaft—cannot avoid constantly changing the state of tension of the muscles of his thigh if a weight and pulley are attached to his limb. The counterpoise is the weight of his body. Every time he tries to shift the position of his shoulders by digging his elbows into the bed he alters the tension of his muscles, calling forth a reflex spasm. When he falis asleep and his muscles relax, when he moves in his sleep, when he is lifted upon a bedpan or moved slightly by the nurses to have his bed put straight, there is apt to recur this reflex contraction due to sudden change in tension.
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