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A plastic operation for ununited fracture of the hip
A PLASTIC OPERATION FOR UNUNITED FRACTURE OF THE HIP* LEWIS CLARK
WAGNER,
M.D.
NEW YORK
I
WOULD like to preface these remarks by saying that the procedure I wiII now introduce is not whoIly new, but based on the principIes of the reconstruction operation of Whitman and the Murphy operation for ununited fracture of the neck of the femur. It is based on the assumption that the fractured head is viable and that by proper apphcation to the reconstructed neck there wiI1 be firm union. The advantage of this procedure is that a norma joint is obtained and in addition to a painless stabIe hip there is a considerabIe amount of motion. The 2 cases done by this method by Dr. NicoIa and myseIf have been exceedingIy satisfactory and warrant a continuation of the procedure unti1 we have a Large series which we can draw definite from concIusions. The usua1 semicircuIar incision extending downward from the anterior superior
RIB GRAFTING ARMITAGE
spine and across the thigh beIow the region of the trochanter is made. The trochanter is reflected with its muscIe and the shaft of the femur disIodged. The neck is rounded and shaped in the usua1 manner; the head of the femur is removed compIeteIy from the acetabuIum and reamed out sufficientIy to assume a cup shape and fit secureIy over the rounded head of the femur. The cup-shaped head is heId in pIace by a smaI1 bone nail. The reconstructed femur is then pIaced within the acetabuIum and the trochanter dispIaced downward and fixed. The wound is then cIosed and the leg is pIaced in a fair degree of abduction and a pIaster-of-Paris spica appIied. The pIaster is Ieft on six weeks and waIking is begun upon its remova1. It is surprising the amount of motion and function that quickIy returns. Neither of these 2 cases have had physica therapy.
FOR SCOLIOSIS*
WHITMAN,
M.D.,
F.A.C.S.
NEW YORK EFORE describing the detaiIs of the and stiI1 further coIIapse of his spine. He operation of rib resection and rib had worn apparatus of a11 types: braces, grafting suppIementa1 to spine fucorsets and pIaster jackets. In spite of a11 sion, a summary of its deveIopment might precautions he repeatedIy deveIoped a make its scope and indications more cIear. pressure sore over the point of greatest Nine years ago a patient came under my convexity of the ribs. At such times he was care, suffering from progressive scohosis forced to enter the hospita1 and he in bed of the most severe type, with an extreme to permit heaIing of the uIcerated area. razor-back deformity. He couId not for a As time progressed this heahng became moment discard apparatus without the more sIow due to constantIy Iowered tissue deveIopment of constitutiona symptoms vitaIity. FinaIIy the uIcer was excised. The * Read at Sixteenth Annual Meeting of Alumni of Hospital for Ruptured & Crippkd, N. Y., Nov. 19-20, 1928.
R
801
WAGNER,
M.D.
NEW YORK
I
WOULD like to preface these remarks by saying that the procedure I wiII now introduce is not whoIly new, but based on the principIes of the reconstruction operation of Whitman and the Murphy operation for ununited fracture of the neck of the femur. It is based on the assumption that the fractured head is viable and that by proper apphcation to the reconstructed neck there wiI1 be firm union. The advantage of this procedure is that a norma joint is obtained and in addition to a painless stabIe hip there is a considerabIe amount of motion. The 2 cases done by this method by Dr. NicoIa and myseIf have been exceedingIy satisfactory and warrant a continuation of the procedure unti1 we have a Large series which we can draw definite from concIusions. The usua1 semicircuIar incision extending downward from the anterior superior
RIB GRAFTING ARMITAGE
spine and across the thigh beIow the region of the trochanter is made. The trochanter is reflected with its muscIe and the shaft of the femur disIodged. The neck is rounded and shaped in the usua1 manner; the head of the femur is removed compIeteIy from the acetabuIum and reamed out sufficientIy to assume a cup shape and fit secureIy over the rounded head of the femur. The cup-shaped head is heId in pIace by a smaI1 bone nail. The reconstructed femur is then pIaced within the acetabuIum and the trochanter dispIaced downward and fixed. The wound is then cIosed and the leg is pIaced in a fair degree of abduction and a pIaster-of-Paris spica appIied. The pIaster is Ieft on six weeks and waIking is begun upon its remova1. It is surprising the amount of motion and function that quickIy returns. Neither of these 2 cases have had physica therapy.
FOR SCOLIOSIS*
WHITMAN,
M.D.,
F.A.C.S.
NEW YORK EFORE describing the detaiIs of the and stiI1 further coIIapse of his spine. He operation of rib resection and rib had worn apparatus of a11 types: braces, grafting suppIementa1 to spine fucorsets and pIaster jackets. In spite of a11 sion, a summary of its deveIopment might precautions he repeatedIy deveIoped a make its scope and indications more cIear. pressure sore over the point of greatest Nine years ago a patient came under my convexity of the ribs. At such times he was care, suffering from progressive scohosis forced to enter the hospita1 and he in bed of the most severe type, with an extreme to permit heaIing of the uIcerated area. razor-back deformity. He couId not for a As time progressed this heahng became moment discard apparatus without the more sIow due to constantIy Iowered tissue deveIopment of constitutiona symptoms vitaIity. FinaIIy the uIcer was excised. The * Read at Sixteenth Annual Meeting of Alumni of Hospital for Ruptured & Crippkd, N. Y., Nov. 19-20, 1928.
R
801