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New Zealand Medical Services in Middle East and Italy

Special Surgical Work at this Period

Special Surgical Work at this Period

1. The Use of Acrylic Plates in Head Cases: This was carried out by Major Shoreston at 58 General Hospital at Trasimene in cases page 599 of cranial defect deemed suitable and where infection was not likely to ensue. The moulded plastic was sutured to the pericranium and the wound sutured without drainage. It was said that the plastic gave no tissue reactions. The temporary results seemed satisfactory.

2. The Use of Plates and Screws in the Treatment of Fractures: This was done in two British base hospitals, both simple and compound fractures being dealt with. The technique used was that of Lane, with long six-inch screws and stainless steel plates. In addition, single screws were used across the actual fractured bone ends to prevent angulation. Most of the cases were of fracture of the femur, but fractures of the tibia and also of the radius and ulna were also plated.

In compound fractures wound suture was generally carried out and, if this was impossible, the muscles were sutured so as to shut off the bone from the open wound. Penicillin was employed both locally and parenterally. Early joint movements were carried out. The preliminary results were on the whole good, but great care in the selection of suitable cases was necessary and the approach became steadily more conservative. This experimental work was confined to two hospitals and was not attempted in our units. We felt that the results obtained by ordinary methods rendered plating unnecessary and undesirable except in specially difficult cases. The use of screws across the fractured bone ends, though efficient mechanically, appeared to be contrary to sound surgical principles. One bad case in twenty-five would make the use of plates and screws inadvisable. The difficulty we foresaw was that the surgeon performing the original operation did not, and probably would not, see the failures.