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DISTRACTOR FOR FRACTURED LEG
690 or where the risk of operation was higher than Until the potentialities of the drug had been fully explored, all patients should be treated at centres MANCHESTER MEDICAL SOCIETY where facilities for control were available. Prof. JOHN MORLEY said that at the moment surgical A MEETING of this society on Oct. 4 was devoted to treatment seemed to give the best results ; the objections Thyrotoxicosis and Thiouracil to thiouracil were that it does not cure, increases the size Dr. M. L. THOMSON said that treatment with thiouracil of the goitre (requiring more urgent removal), necessiseemed to be symptomatic rather than curative, and the tates continuance of treatment, and carries a great hope of a cure lay in maintaining the patient’s health risk of agranulocytosis. Its effects were slower than, and until the thyroid gland returned to normal. Among inferior to, those of iodine in preoperative treatment, 109 published cases there was 1 fatal case of agranuloand it produced troublesome vascularity of the gland. cytosis in a patient receiving 2 g. daily. Of 13 cases he His operative results showed only 51 (2-4%) deaths in himself had treated over periods up to 9 months, 3 were a series of 2094. Mr. R. W. WYSE referred to the operative difficulties, submitted-to operation, 1 because of rapid increase in the goitre (in a girl aged 15), 1 because of neutropenia a arising from increased vascularity, in those of Dr. Thomson’s cases requiring surgical treatment after week after treatment began, and 1 at the patient’s request. The remaining 10 showed a good response taking thiouracil.-Mr. WILSON HEY was interested in the possibility of using thiouracil as a diagnostic to the drug, but relapsed 2-8 weeks after it was discontinued. During the initial 10 days when 0-6 g. was test.-Dr. J. F: WILKINSON ’emphasised the need for given daily the patient should be in the ward and care in testing these new drugs, in view of the risk of frequent white-cell counts were needed. Later at least undesirable toxic effects such as agranulocytosis, acute weekly attendance-as an outpatient was essential for haemolytic anaemia, and thrombocytopenic purpura. Such treatment should be given only in hospitals or clinics white-cell counts and observation. During this period where adequate constant control could be maintained. He a dosage of 0-2 g. daily was usually necessary until the patient’s weight returned to normal. As a further had had good results with thiouracil in cases unsuitable maintenance dose 0.1 g. or even 0-05 g. daily might for X-ray or surgical treatment or where these had suffice. There were 3 cases of chronic auricular fibrillafailed.-Dr. REGINALD ELLIS had noted vomiting after the use of thiourea, with immediate relief on cessation tion and 1 was regularised by thiouracil. There were no toxic complications apart from neutropenia in 1 case, of the treatment ; iodine subsequently produced its transient maculopapular eruption (1), transient itching normal response. One patient had remained well for 3 months after initial treatment with thiouracil but had of the skin (2), and doubtful drug fever (1). The impression gained was that the main field of usefulness for then shown a sudden recurrence of thyrotoxic symptoms thiouracil at present was in cases judged unsuitable for which did not respond to thiouracil.
operation
Medical Societies
usual.
.
been lost by
New Inventions
ing the
DISTRACTOR FOR FRACTURED LEG THE appliance described here was originally devised to suit emergency conditions at an EMS hospital with limited orthopaedic equipment, but reduction with this distractor has proved to have definite advantages which may justify its wider use. The apparatus consists of a footboard with a groove cut to fit the leg of whatever table is in use (fig. 1). Through the pulley fitted into the same board runs the traction cord, which is attached to the shorter arm of a lever supported by a block two or more inches high to give the lever a sufficient range of excursion. No screws or turnbuckles are needed. The patient is placed on the table with the fractured leg hangingat a right angle over the edge or over a firm support (fig. 2). A pin or wire through the os calcis is connected with a stirrup and the cord is attached to the stirrup. The operator sits in front of the leg. He can now depress the lever with his foot while his arms are free to manipulate the fracture. He can achieve the desired degree of distraction with a minimum of effort and with notime lost with screwing and unscrewing, as with the rigid types of distractors. The " elasticity " of the device enables him to feel his way through all the stages of the reduction, and he has only, to relax slightly the pressure on the lever and his sense of touch will tell him whether impaction has taken p l a c e. Herein lies one of the principal advantages of the tus. Screw devices convey sometimes a false sense of security, and radiograms do not always tell us the degree of impaction with, certainty. The dangers of distraction of fragments, especially in lower leg fractures, need no emphasis. Occasionally one may overestimate the chances of manipulative reduction in a particular fracture-e.g., in some spiral fractures-and little will then have
appara-
using this method in the first place.
pressure
on
the lever allows
one
to
Relaxdetect
the case in which repeated dis-
placement of the fragm e n t
s
occurs; one will then be able to pro-
ceed with
out d e l a y to open
reduction and internal fixation, if so desired. The operator will be
spared the unpleasant surprise of slipped " fragments some days "
or
weeks
later, after the leg has been put into plaster-
of-paris.
2—The distractor Fig. 2—The distractor apparatus.
Once the fracture is reduced, a plaster,cast is applied with the pin or wire incorporated. It may sometimes be tiresome to keep the foot on the lever all the time until the plaster cast has set or while a compound fracture is dealt with, and an attendant can then fix the traction cord by fastening a clip to it just behind the pulley. The device can be made by any hospital joiner without difficulty at the cost of a few My model was made by Mr. G. Rollisson, our joiner, who assisted me with his technical advice. The apparatus has also proved satisfactory at the EMS Orthopaedic Hospital at Pinderfields in more than a score of suitable cases. I have to thank Mr. Geoffrey Hyman, consultant orthopaedic surgeon at that hospital, for putting it on’trial and for his constructive criticism.
shillings.
County Hospital, Keighley.
M. P. LAUFER,
MD BRNO.
operation
Medical Societies
usual.
.
been lost by
New Inventions
ing the
DISTRACTOR FOR FRACTURED LEG THE appliance described here was originally devised to suit emergency conditions at an EMS hospital with limited orthopaedic equipment, but reduction with this distractor has proved to have definite advantages which may justify its wider use. The apparatus consists of a footboard with a groove cut to fit the leg of whatever table is in use (fig. 1). Through the pulley fitted into the same board runs the traction cord, which is attached to the shorter arm of a lever supported by a block two or more inches high to give the lever a sufficient range of excursion. No screws or turnbuckles are needed. The patient is placed on the table with the fractured leg hangingat a right angle over the edge or over a firm support (fig. 2). A pin or wire through the os calcis is connected with a stirrup and the cord is attached to the stirrup. The operator sits in front of the leg. He can now depress the lever with his foot while his arms are free to manipulate the fracture. He can achieve the desired degree of distraction with a minimum of effort and with notime lost with screwing and unscrewing, as with the rigid types of distractors. The " elasticity " of the device enables him to feel his way through all the stages of the reduction, and he has only, to relax slightly the pressure on the lever and his sense of touch will tell him whether impaction has taken p l a c e. Herein lies one of the principal advantages of the tus. Screw devices convey sometimes a false sense of security, and radiograms do not always tell us the degree of impaction with, certainty. The dangers of distraction of fragments, especially in lower leg fractures, need no emphasis. Occasionally one may overestimate the chances of manipulative reduction in a particular fracture-e.g., in some spiral fractures-and little will then have
appara-
using this method in the first place.
pressure
on
the lever allows
one
to
Relaxdetect
the case in which repeated dis-
placement of the fragm e n t
s
occurs; one will then be able to pro-
ceed with
out d e l a y to open
reduction and internal fixation, if so desired. The operator will be
spared the unpleasant surprise of slipped " fragments some days "
or
weeks
later, after the leg has been put into plaster-
of-paris.
2—The distractor Fig. 2—The distractor apparatus.
Once the fracture is reduced, a plaster,cast is applied with the pin or wire incorporated. It may sometimes be tiresome to keep the foot on the lever all the time until the plaster cast has set or while a compound fracture is dealt with, and an attendant can then fix the traction cord by fastening a clip to it just behind the pulley. The device can be made by any hospital joiner without difficulty at the cost of a few My model was made by Mr. G. Rollisson, our joiner, who assisted me with his technical advice. The apparatus has also proved satisfactory at the EMS Orthopaedic Hospital at Pinderfields in more than a score of suitable cases. I have to thank Mr. Geoffrey Hyman, consultant orthopaedic surgeon at that hospital, for putting it on’trial and for his constructive criticism.
shillings.
County Hospital, Keighley.
M. P. LAUFER,
MD BRNO.