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The lead hand revisited
THE LEAD HAND REVISITED Editor’s note: I had always supposed the origins of the lead hand to be lost in the mists of surgical antiquity and its inventor, like that of the wheel, to be unknown. I recently discovered that this is far from true. It was devised by Mr GeoJi-ey Fisk, who described it in The Lancet on 25 December 1948 (page 1013). That report is reproduced, with permission, on the right. Below is an account which Mr Fisk has kindly written, describing the origins of this invaluable invention. There are, of course, several more complicated and more expensive devices for holding the hand still while you operate on it: I have tried some of these but reverted to the lead hand because I found it simpler and quicker to use and just as versatile. Mr Fisk, who is now 75, recently took his degree of M.Phil. (Cantab.) in Biological Anthropology. His thesis was entitled “The Pathology of the Spine in Nubians and Egyptians” and was based on a study of the vast collection of skeletons from the excavations from the Aswan dam in Egypt in 1907, which are housed in the Department in Cambridge and have never before been seen by a clinician.
Guy Pulvertaft was the most equable of men and a meticulous and patient surgeon. He was Civilian Advisor in Orthopaedics to the R.A.F. Hospital at Northallerton during the time I had charge of the orthopaedic division there. However his attempts at controlling the hand during surgery upon it (and his growing reputation in hand surgery attracted the transfer of many service personnel to Northallerton) resulted in repeated episodes of frustration. On one such occasion he declared “I wish someone would invent some way of holding the hand during operation!” On my next leave, I started experimenting with various designs and materials. I finally concluded that sheet lead was sufficiently malleable to control the digits and heavy enough to anchor the hand to the operating table. After cutting several patterns, I settled on a design which has remained unmodified even after 43 years. The new splint was well received on my return to duty; I made several copies and distributed them with templates to my seniors in the orthopaedic world. Their approval and adoption encouraged me finally to submit a description to The Lancet. Many modifications have been attempted both in design and material. Instrument makers have reproduced these versions under different names but none, as far as I know, have acknowledged or indeed been aware of the origin of the lead hand. 464
New Inventions SPLINTAGE
OF
THE
HAND
DURING
OPERATION
EFFECTIVE fixation of the ha.nd during operations 011 it is alwa.ys diff~cull, and often a source bf irritation. Ma.ng SUPKWIV have an assistant to hold the hand in Ihe _ required posit ioil ; some are content to try and conl.rol the limb wit II strips of‘ ~:‘:LI.IzP,t owe1 clips, strapping, AX. ; while otllers llse a ricicl metal or wooden sl,iirtt. I-lut such metllods do not. &&it, of ready adjustment during opeMions which a.re couunonly long and tedions and likely to involve alterations in position. A4t their best thcp restrict the surgeon’s field OF operation and tend to block his view. The splint described here overcomes t.hcsc disnclrnntages It, consist.s nlcrely of a fiat and is extremely simple. shape cut from n sheet, of lcnd 12 in. by 12 in. and ‘/,6 in. thick (fig. 1). The hand is laid on t lrc splint, which is then accurCately moultlcd round it. The fingers arc fixed by bending tllc tips of the splint OVCI thenl (fig. 2), or if necessary they can be held straight. by making gutters
Fig. I.-Outline
of splint sheet lead.
cut from
Fig. I.-The
splint
applied.
of the metal tongues. The thumb is held by an additiona.1 piece at the side. The wrist is bent into the required position, and the side bars are folded obliquely round the forearm. The following advantages are claimed for this form of leaden splint :
(1) It can be quickly and accurately moulded into any It may bc applied equally well to the back position. or front of either hand and to a limb of any size. The hand and fingers arc firmly held without the use of clips, straps, or retractors. It is particulnl~ly useful in operations on the side of the finger, since the other digits can be held effectively out of the way. (2) Sheet lead of this thickness is suficiently malleable to be easily bent by hand, and is soft enough not to damage the tissues by pressure or t,o tear t.hct surgeon’s At the same time it is sufl?cientlg rigid to fix gloves. the hand in the position required. If further support is needed, the hand encased in the splint may be rested on a folded towel. (3) The splint is easily sterilisccl by boiling and may be applied safely either directly to the hand or over a stockinette glove. (4) It is quickly and cheaply made, is durable, and can be rapidly bent or hammered flat again after use. (5) It releases an assistant and affords the surgeon a clearer field of operation. My thanks WC due to Mr. It. G. Pulvertaft, both because his walk on the surgery of the hand stimulated me to develop this splint,, and for his willingness to tly it, and later to adopt it as a regular part of his cquipmcnt. GEOFFREY R. FISK Cnmbridgc.
11 .u
. Loncl .) I?.1%.C .Y.E .
Guy Pulvertaft was the most equable of men and a meticulous and patient surgeon. He was Civilian Advisor in Orthopaedics to the R.A.F. Hospital at Northallerton during the time I had charge of the orthopaedic division there. However his attempts at controlling the hand during surgery upon it (and his growing reputation in hand surgery attracted the transfer of many service personnel to Northallerton) resulted in repeated episodes of frustration. On one such occasion he declared “I wish someone would invent some way of holding the hand during operation!” On my next leave, I started experimenting with various designs and materials. I finally concluded that sheet lead was sufficiently malleable to control the digits and heavy enough to anchor the hand to the operating table. After cutting several patterns, I settled on a design which has remained unmodified even after 43 years. The new splint was well received on my return to duty; I made several copies and distributed them with templates to my seniors in the orthopaedic world. Their approval and adoption encouraged me finally to submit a description to The Lancet. Many modifications have been attempted both in design and material. Instrument makers have reproduced these versions under different names but none, as far as I know, have acknowledged or indeed been aware of the origin of the lead hand. 464
New Inventions SPLINTAGE
OF
THE
HAND
DURING
OPERATION
EFFECTIVE fixation of the ha.nd during operations 011 it is alwa.ys diff~cull, and often a source bf irritation. Ma.ng SUPKWIV have an assistant to hold the hand in Ihe _ required posit ioil ; some are content to try and conl.rol the limb wit II strips of‘ ~:‘:LI.IzP,t owe1 clips, strapping, AX. ; while otllers llse a ricicl metal or wooden sl,iirtt. I-lut such metllods do not. &&it, of ready adjustment during opeMions which a.re couunonly long and tedions and likely to involve alterations in position. A4t their best thcp restrict the surgeon’s field OF operation and tend to block his view. The splint described here overcomes t.hcsc disnclrnntages It, consist.s nlcrely of a fiat and is extremely simple. shape cut from n sheet, of lcnd 12 in. by 12 in. and ‘/,6 in. thick (fig. 1). The hand is laid on t lrc splint, which is then accurCately moultlcd round it. The fingers arc fixed by bending tllc tips of the splint OVCI thenl (fig. 2), or if necessary they can be held straight. by making gutters
Fig. I.-Outline
of splint sheet lead.
cut from
Fig. I.-The
splint
applied.
of the metal tongues. The thumb is held by an additiona.1 piece at the side. The wrist is bent into the required position, and the side bars are folded obliquely round the forearm. The following advantages are claimed for this form of leaden splint :
(1) It can be quickly and accurately moulded into any It may bc applied equally well to the back position. or front of either hand and to a limb of any size. The hand and fingers arc firmly held without the use of clips, straps, or retractors. It is particulnl~ly useful in operations on the side of the finger, since the other digits can be held effectively out of the way. (2) Sheet lead of this thickness is suficiently malleable to be easily bent by hand, and is soft enough not to damage the tissues by pressure or t,o tear t.hct surgeon’s At the same time it is sufl?cientlg rigid to fix gloves. the hand in the position required. If further support is needed, the hand encased in the splint may be rested on a folded towel. (3) The splint is easily sterilisccl by boiling and may be applied safely either directly to the hand or over a stockinette glove. (4) It is quickly and cheaply made, is durable, and can be rapidly bent or hammered flat again after use. (5) It releases an assistant and affords the surgeon a clearer field of operation. My thanks WC due to Mr. It. G. Pulvertaft, both because his walk on the surgery of the hand stimulated me to develop this splint,, and for his willingness to tly it, and later to adopt it as a regular part of his cquipmcnt. GEOFFREY R. FISK Cnmbridgc.
11 .u
. Loncl .) I?.1%.C .Y.E .