Lectures on orthopedic surgery . immobilization by an ambulatory apparatus ispractically out of the question. The ambulatory appara-tuses that have seemed most successful have aimed at theaccomplishment of twothings: Immobilizationby circumferential com-pression by a broad girdleand limitation to volun-tary motion by a spinalapparatus that restrictsforward bending. Thereis no question that motionin the lumbar spine iscontraindicated and thereshould also be no ques-tion that motion at thehip-joint is also contra-indicated, but restrictionof the latter has not beenattempted by an ambu-latory app
Lectures on orthopedic surgery . immobilization by an ambulatory apparatus ispractically out of the question. The ambulatory appara-tuses that have seemed most successful have aimed at theaccomplishment of twothings: Immobilizationby circumferential com-pression by a broad girdleand limitation to volun-tary motion by a spinalapparatus that restrictsforward bending. Thereis no question that motionin the lumbar spine iscontraindicated and thereshould also be no ques-tion that motion at thehip-joint is also contra-indicated, but restrictionof the latter has not beenattempted by an ambu-latory apparatus, as itwould prevent the pa-tient from sitting. Thefact that the girdle, in acertain number of cases,relieves pain, which isnot relieved, but too oftenaggravated, by traction,points very suggestivelyin the direction of thetrue and of the falseprinciples of the treat-ment of all joint-disease, namely, that a force thattends to immobilize, even when associated with a forcethat crowds together the articular surfaces, relieves. Fig. 77.—Patient in apparatus. Braceshould be bandaged to the thighs justabove the knees. 118 pain, whereas a force that tends to separate the joint-surfaces without immobilization fails to relieve, andoften increases the suffering. The mechanical treatment that we employ is someone of the modifications of the Thomas double hip-splint. The main stems should be separated at such adistance as to pass to the outer side of the posteriorsuperior spines of the ilia, and lateral wings should beattached to the stems to pass around the flank on eitherside. One of us (R. J.) is accustomed to use the formof splint depicted in Figs. 76 and 77, and the other(J. K) uses the same frame, but adds a broad sling ofleather stretched from one stem to the other and reach-ing from the coccyx to the mid-lumbar region; both ofus bandage the thighs to the stems. This is not de-picted in the illustrations. The patient is to be keptcontinuously recumbent for so long as any act
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Keywords: ., bookcentury1800, bookdecade1890, booksubjectorthopedics, bookyear
