Modern Methods in the Treatment of Fractures

PPAPER READ BEFORE THE NORTH-EAST `BRANCH OF THE 'BRITISH MEDICAL ASSOCIATION I HE treatmenit of fractures is of perenniial interest. rhe complaint is common to any age. It may occouLr at any time of life. A fracture may usher in the new-born babe. It may ring down the curtain at the otherend of life. rhe fre(luency of the complaint is not diminishing. With the increase in speed it is actually increasing. It is only by using a high standard of comparison that a high standard of treatment can be obtained. In fractures that standard is the reproduction of the normal. To obtain it, Lister violated the canons of surgery. He converted a simple fracture iiato a compounld one when he wired a fractured patella. But the genius of Lister did not popularize the method. It took the technical skill and personality of Lane to show that the opening up of a simple fracture, and fixing of the fragments in accurate anatomical apposition, was a justifiable and even desirable method. The advent of X-rays was the cause of the next advance in the treatment of fractures. It was no longer necessary to cut down on the seat of fracture to see the position of the bony fragments. It was found that manipulation in itself, if assisted by Xray examinations, could produce good anatomical apposition in certain fractures. X-ray examinations were especially helpful to those who followed the teaching of Hugh Owen Thomas: they cotuld now watch the progress of their fractures, and their treatment became more of an exact science. In this way treatment in the Thomas splint became more popular. The exigencies of war finially set the treatment of fractures on1 its present basis. It showed the weak poinlts in the metlhods of open operation. The septic nature of the wounds drove surgcons to dispense with Lane's fixation methods by foreign bodies and to use tractioni as a means of holding the fragments in apposition. It was found that the results obtained by traction were better than those obtained by operative fixation, and the mortality was greatly lowered. This, coupled with an efficient method of keeping the fragments from moving during transport, lowered the total mortality for fractured femora from eighty to sixteen per cent. The method adopted in our lines was the universal use of the Thomas ring-splint. Our enemies learnt the same lesson, and they had a like drop in their mortality; the splint adopted and modifiedl by them was the Braun splint. The Thomas splint has the advantage over the Braun splint in that it is more easily adopted for transport and it allows of more movement of the limb without allowing movement of the fragments. The war signed the death warrant of plates and screws. It exalted the ring-splint of Hugh Owen Thomas. It established the principle of skeletal traction. When a force is applied to a bone, it is fractured in the direction of the line of force. A twisting force will produce a spiral fracture, and a direct blow a transverse fracture.