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War Surgery and Medicine



In the early part of the war the Trueta closed plaster method was used for fractures of the arm and leg, and the Thomas splint for fracture of the thigh. During the first Libyan campaign great page 281 difficulties arose with regard to the forward treatment, and especially the evacuation of fracture casualties. Transport in ambulances across the roadless desert caused great suffering to the fractured femur cases, and extension and fixation in the Thomas splint was not satisfactory. Colonel Monro, Consultant Surgeon MEF, suggested the utilisation of plaster in conjunction with the Thomas splint and this was done by the Australian and British units at Tobruk, whence long evacuation by road and desert was at first necessary. They applied an enclosed plaster splint from the toes to the groin and then over the plaster applied a Thomas splint to the limb, the original Tobruk splint. This splint, either in its original or else in modified form, soon became established as a routine for the forward treatment of fractured femurs and remained so throughout the war. The use of extension produced difficulty during transportation till it was realised that only sufficient extension should be applied to fix the limb, and that anything more was neither desirable nor practicable, and merely produced overriding of the ring over the tuber ischii.

The arm fractures were splinted in the forward areas with Kramer splinting and, after operation, with closed plaster splints. Abduction plasters were generally unsuitable in the forward areas. Difficulty arose during transport unless the patient could travel in a sitting position, and this led to the utilisation of plaster bandages to fix the splinted arm to the chest, which gave greater but not perfect comfort.

Unpadded plasters, especially for leg fractures, were found to endanger the circulation of the limbs owing to swelling during evacuation. Padded plasters were then used, and they were also split before the patient was evacuated to another unit.

The closed plaster treatment was continued at the Base, except when treatment of infection delayed healing and called for the utilisation of the Thomas or other splints. Abduction splints were used for shoulder cases. The femur cases were treated in a Thomas, or sometimes a Braun splint, with extension by means of Steinmann pins through the crest of the tibia. Weight extension was usually employed, and regulated by measurement and X-rays.

Plates and screws were used in British orthopaedic centres in Italy, but these proved unsatisfactory in compound fractures, though of use in certain types of simple fracture, especially of the radius and tibia. Stress was laid on the restoration of the functional activity of the limb more and more as the war continued. The usefulness of the hand was held to be the main aim of treatment in any injury to the arm, and the preservation of movement at the knee, and in the foot and ankle, was also of great importance in the lower limb.

Patients with fractures of the femur, hip, and pelvis were held in the base hospitals overseas until union had taken place, but all other page 282 fractures were evacuated to New Zealand whenever a hospital ship was available. The retention of these cases followed serious trouble resulting from the too early evacuation by hospital ship of patients wounded during the second Libyan campaign. Some of the patients in plaster spicas or Thomas splints were badly upset by the journey from Cairo to Suez, and others developed plaster sores. No further patients of this type were evacuated to New Zealand till their condition had become quite stabilised and infection had subsided. There was no further difficulty of this kind throughout the war.