Licence: Public Domain Mark
Credit: Surgical cases and essays / by Rushton Parker. Source: Wellcome Collection.
Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.
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![just long enough to press on the jierineum in llie altitude of full linear extension ( e, 6). Fractures of the neck, or immediately below the great trochanter, are best treated in Thomas's hii)-splint (/), applied exactly as in hip- joint disease (i, 2). In fracture of tlie neck without im])action,as there is not seldom an absence of siiortening at first, it is well to apjily the splint as early as possible after the receipt of the injury ; in fact, when opportunity occurs, before the jjatient is moved at all. Otherwise, during transport shortening to even a great extent may any moment be caused. In impacted fracture the shortening is accepted, but the use of this sjjlint is found to be most gratifying, not only by removing and diminish- ing pain, but by greatly extending the patient's liberty. The unassisted use of the bed-pan and other considerable voluntary changes of situation and attitude can be painlessly effected in bed, with the aid of the hands and the other leg, and tlie enforced recumbency thus made less wearisome. The bed should be soft for the use of both kinds of splints ; in that for the hip the patient lying chiefly upon the back, which should be uniformly supported by the bed, into which, when sufficiently soft, the splint is de])ressed, and ])revented from bear- ing more than a trifling share of the recumbent weight of the body. In the event of recent shortening in unimjiacted fractiux of the neck, in a vigorous patient at or under the middle age, extension straps should be well fixed to the thigh, and tied to the lower end of the splint, whicli then siiould have no shoulder bands, and wliich, by its observed tendency to slip downwards towards the feet, will be found to act as a sufficient drag in maintaining the length of the limb. But if that do not prove enough, the inner horn of the thigh crescent may be thickly but firmly covered with extra i)adding, and comfortably employed m counter-pressure on the iscliium i). When locomotion is resumed, on the cessation of all tenderness and the occurrence of union, the injured limb is kept off the ground, and all flexion and other possible strain avoided at the now pliable neck, by the use of crutches under the arms, a wooden clog, or iron patten, under the boot of the sound leg, I](https://iiif.wellcomecollection.org/image/b22278345_0012.jp2/full/800%2C/0/default.jpg)
