Internal fixation of femoral neck and intertrochanteric fractures

INTERNAL FIXATION OF FEMORAL NECK AND INTERTROCHANTERIC FRACTURES* USE OF ANCHOR

SACRAL JOHN

REST AND GALLAGHER

PROTRACTOR

T. F. GALLAGHER, M.D. IMadison, Il’isconsin

0

the

VER 2,400 years ago Hippocrates, lineal descendent of the mythical Aesculapius, observed in his book on articuIations’ that, “Any person who

or lie on) to facilitate the reduction of disIocations of the hip joint.” His detailed description of the apparatus contains practicahy all the basic principles of the present day frac-

FIG. I. Scanmum

practices medicine in a popuIous city shouId have prepared a quadrangmar board, scamnum or bathron, (meaning a bench that you sit

Hippocrates.

ture tabIe. Our modifications of the scamnum in this era are mereIy refinements, which sometimes adhere to and sometimes detract from the

* From the Jackson Clinic, Madison, Wis. 308

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Gallagher-FemoraI

Neck

and

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Fractures

FIG. 2. Patient on Hawley tabIe with sacra1rest attachment.

FIG. 3. Protractor. unaIterabIe basic principIes of balanced traction and countertraction known in antiquity. (Fig. 1.1 For the past year we have been using the peIvic anchor sacral rest3 in the operative fixation of fractures about the hip joint. The apparatus has several advantages heretofore not incorporated in any modern fracture tabIe, nameIy, it is adaptabIe to patients of a11 sizes and ages from the cradle to the grave. It permits rigid fixation of the pelvis without undue

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pressure, and it aIIows uniIatera1 Ieg traction in a11 directions by whatever method of reduction the operator chooses without disturbing the peIvis. It permits distribution of pressure from traction over a wide area reducing the number of pounds of pressure per square inch of skin surface to a minimum. With uniIatera1 Ieg traction the well Ieg can be sIung in any convenient position in muscle balance to accommodate the IateraI portabIe x-ray equipment. It insures uniformIy exceIIent

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FIG.

Neck

4.

and

Intertrochanteric

Fractures

Protractor overIay postreduction.

FIG. 5. Protractor sterile set-up during operatron.

FIG. 6. Case I. Original injury.

anteroposterior and IateraI x-ray fiIms with the least possibfe inconvenience to the operator and a pleasure to the technician who is unhampered in his work and is excIuded from the operative field. The set-up opens the door for further improvements a11 of which do not occur to one individual. (Fig. 2.) After employing the contrivance for the first time it occurred to us, in view of the fact that the head and neck of the femur aIways appeared centered on the anteroposterior fiIm, that it should be a reIativeIy simpIe matter to devise a protractor to attach to the upright posts of the sacral rest. Such a device wouId insure an accurate introduction of whatever fixative material is desired for the case at hand.

Accordingly, we had made a solid stainIess steel instrument consisting of two taperecl hemispheres and a protractor with multiple guide rods mounted on a cross beam that also serves as an accurate guide for the lateral x-ray equipment. AI1 parts are adjustable and controlled by simpIe set screws. The circumference of the protractor is perforated at intervals of 5 degrees, and the centra1 indicator rod perforated at fi inch intervaIs. The instrument is adaptabIe to either right or left hip by simpIy reversing the protractor on the cross beam. The protractor acts as an overIay on the anteroposterior x-ray film. It can be steriIized and is equaIIy effective before and after draping the patie’nt due to the weight of the hemispheric supports. (Figs. 3, 4 and 5.)

American Journal of Surgery

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FIG. 7. Postreduction.

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FIG. 8. Process of introducing SmithPetersen nai1 with aid of protractor.

FIG. g. Case II. OriginaI injury.

The following case histories illustrate the use of the sacra1 rest and protractor in femorat neck and intertrochanteric fractures. CASE

REPORTS

CASE I. An eighty-six year old white female; No. 86-076, feIl at home injuring her Ieft hip. X-ray on May 19, 1951, reveaIed disptaced subcapita1 fracture. Fixation was done with Smith-Petersen nail on May z3rd utiIizing sacra1 rest and overIay protractor. The patient was discharged from the hospita1 on crutches with weight-relieving waIking

March,

Igf2

caliper on JuIy 3rd. Progress is excelrent to date. (Figs. 6, 7 and 8.) CASE II. A sixty-four year oId white female, No. 174-908, tripped and feII injuring her Ieft hip on March 21, 1951. X-ray reveaIed intertrochanteric fracture Ieft hip, open reduction with Moe pIate and screw fixation, March 22nd. Postoperative convaIescence was uneventfu1. The patient was discharged from the hospita1 on April 12th. Progress is satisfactory to date with fracture we11healed in vaIgus by x-ray. (Figs. g,Io and I I .)

GaIIagher-FemoraI

Neck

and

FIG. IO. Postreduction.

Intertrochanteric

FIG. I I. Process of applying aid of protractor.

CONCLUSION

Attention has been caIIed to the benefits of the anchor sacraI rest and an overIay protractor in the operative fixation of fractures about the hip joint. Again in the words of the great Hippocrates,4 “The prime object of the physician in the whoIe art of medicine shouId be to cure that which is diseased and if this can be accompIished in various ways, the least troublesome shouId be selected.”

Fractures

Moe pIate with

REFERENCFS (a) Loeb Library IHippocrates, vol. III, edited by Withington; (b) ADAMS, F. The Genuine Works of HIppocrates, chapt. 72, On the ArticuIations. New York. 18~0. WiIIiam Wood & Co. (a) Ibid.,lh p. 347, plates IV and V; (b) Manuscript of the commentary of AppoIonius of Citium, edited by H. Sch&e. Mo%eaI, Canada, 1896. OsIer Librarv. McGiII Universitv. HALL, C. L. an2 WELLMERLING, H: W. Pelvic anchor sacral rest. Presented at the International CoIIege of Surgeons’ Meeting, September IO, 1951. Yet to be published. Ibid.,** On the Articulations, chapt. 73. I

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American

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