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In intertrochanteric fractures extension is necessary to maintain a good position.
In these cases a strapping extension is fitted to the fractured limb before the application
of the plaster and the sole of the foot is left free from plaster so that a weight
can be applied. This assures fixed abduction and weight extension.
The advantages of the bar method over a hip spica plaster can be summarised
as follows:—
(1) Ease of application in bed without a special table and prolonged manipulation.
No patient is too old or feeble to stand this procedure.
(2) Comfort and ease of nursing. My ward sisters have expressed their
preference for this method of treatment over any other in facilitating the nursing
of these patients.
(3) The patient can sit up. This is a material advantage in preventing and
combatting the chest complications so liable to occur in these cases.
(4) The thighs are uncovered and massage can be carried out from an early
date.
(5) The hip is not obscured by plaster and clear X-ray pictures can be
obtained.
The abduction is maintained usually for sixteen weeks, after which a walking
caliper splint is fitted. In sub-capital fractures non-union occurs in many cases,
as with all methods of treatment, but fibrous union in good position is obtained and
there is never any eversion of the foot.
I submit this account of this method of treating fractures of the neck of the
femur in the hope that it will prove an addition to the armamentarium of surgeons
called on to treat these difficult cases. In my experience the abduction bar method,
as advocated by Wilkie, is not sufficiently widely known. Apart from its use in
hospital, surely it would be a great help in the treatment of these cases where
hospitalisation is not possible. I have been using my bar for four years and I have
found it extremely useful and satisfactory.
My thanks are due to Dr. Wilson, medical superintendent of Hackney hospital,
for permission to publish this article; to Miss Weill, for the X-ray plates (figs. 4
to 7); and to Mr. Smith, the hospital splint-maker, for much valuable attention
to the design of the apparatus.
Reference.
D. P. D. Wilkie. Surgery, Gynaecology and Obstetrics, 1927, 529.