War Surgery and Medicine
Operative Treatment
Operative Treatment
This was undertaken some weeks after the wound had healed, when physiotherapeutic examination had shown that there was a complete nerve block showing no signs of recovery. The period allowed for recovery naturally depended on the judgment of the neurologist and the surgeon, but generally in England operation was not delayed very long, and, following the introduction of secondary suture of wounds, the waiting period was very much shortened.
Our New Zealand routine was a reasonable compromise between the conservative attitude of the neurologist and the enthusiasm of the surgeon. A large number of nerve sutures were performed in both our main hospitals, the technique being that adopted by the leading British orthopaedic surgeons. This technique consisted of:
After operation the splinting and physiotherapeutic treatment by galvanism, massage, and joint movements was regularly carried out till function returned—a long, tedious business.
The results obtained during the 1914–18 War were only moderately satisfactory, and varied considerably in the different nerves. This was dependent on several factors:
(1) | The time of suture after the injury. It was determined that very late sutures gave little hope of any success. |
(2) | The extent of damage to the nerve, especially the length of nerve involved. |
(3) | The extent of the muscular atrophy, especially in relation to the smaller muscles such as the intrinsics of the hand. |
(4) | The condition of the joints and the presence of any deformities. |
It was found that the sensory nerves recovered on the whole better than the motor nerves, but that it was rare to get complete recovery. Motor recovery was frequently rendered impossible by the complete atrophy of the involved muscles, especially those of small size.
When nerve repair was impossible or had been unsuccessful, some functional activity was restored by means of tendon transplantation and arthrodesis. This was found especially useful in paralysis of the radial nerve, and tendon transplantation gave, as a rule, such good results that nerve suture was abandoned in cases of extreme difficulty. Tendon transplants in the foot, on the other hand, did not give the same success, largely because of the extra strength required. Arthrodesis was found of use in the ankle.
At the end of the 1914–18 War the surgery of peripheral nerves had reached a very high standard.
Between the wars the development of orthopaedic and neurological specialism continued steadily, but no very marked changes occurred in treatment or in knowledge.