View report page

TREATMENT OF FRACTURES OF THE NECK OF THE FEMUR.
By James C. Gillies, M.B., Ch.B., F.R.C.S. (Edin.), Assistant Medical Officer,
Hackney Hospital.
The Whitman plaster has for years been recognised as standard treatment for
fractures of the upper end of the femur. The application of a Whitman plaster is a
formidable procedure and many of the patients are too old and infirm to stand it.
The Whitman position of abduction and inversion, the position of choice, can be
attained and maintained by a simpler and more generally applicable procedure.
In 1927 Wilkie published an account of an apparatus which maintained abduction
and inversion. The apparatus I have been using for the last four years at Hackney
hospital was adapted from Wilkie's. It is simpler, cheaper and more adaptable.
It consists of a straight steel bar and two metal plates. The bar is rigid, forty
inches long, half an inch broad and three-sixteenths of an inch thick, perforated
towards its ends by four holes, each hole large enough to admit the screw of one
plate. The plates are of zinc, five inches square, with rounded corners, and with a
long screw and wing-nut projecting vertically from the centre of each (see fig. 1).
The plates can be moulded to fit the leg.
fig. 1.-showing abduction bar and one
plate.
fig. 2.—fractured side left. showing wing
nuts in position and inversion of foot.
fig. 3.—fractured side left. showing abduction and inversion of
left lower extremity with bar applied.
The splint is applied in bed and very little assistance is required, no more than
can be supplied by one nurse. In many of the cases the only anæsthetic used has
been morphia gr. ¼ administered twenty minutes before the beginning of procedure.
Any pain caused by manipulation is momentary and not severe. In younger and more
muscular subjects spinal anaesthesia, induced by 1.5 c.c. of spinocaine, has been
used. In intertrochanteric fractures a local anæsthetic of 20 c.c. of 2 per cent.
novocaine has proved very satisfactory.
A plaster casing is applied to the sound leg over wool, from the toes to below
the knee, with one zinc plate incorporated so that the screw of the plate projects
directly backwards about eight inches above the heel. On the fractured side the
plaster is applied from the toes to above the knee, and the screw of the included
plate is made to project medially and backwards at the same level as the screw on
the sound side. All this part of the proceedings can be done without causing any
pain. When the plaster has hardened, the sound leg is abducted as far as possible,
the screw slipped through a hole at one end of the bar and the wing-nut adjusted.
The fractured limb is now grasped firmly, a strong pull is maintained and the limb
abducted and inverted slowly and steadily until the screw can be inserted into an
(117) i