Medicine: Breakbones, Bonesetters

As the foremost cripple in the world, the American Academy of Orthopedic Surgeons wanted President Roosevelt to attend their banquet in Manhattan last week. They asked one of their colleagues. Dr. Michael Hoke. the President’s good friend and surgeon-in-chief of Georgia

Warm Springs Foundation, to extend the banquet invitation. President Roosevelt regretted that he could not leave Washington, “but I do want to tell you . . . that [your] aim happens to be one of the undertakings closest to my own heart. It is largely through the work of some men who have practiced your specialty that America and the world have progressed so far in the prevention of deformity and in the bringing up of ‘straight’ children.”

Orthopedist Philip Duncan Wilson of Manhattan, president of the Academy, read the message, called off the names of other famed cripples—,Æsop. Richard III, Alexander Pope, Lord Byron, Sir Walter Scott—and pointed to one-legged Dramatist Laurence Stallings who was at the speakers’ table of the banquet. From their successes Dr. Wilson drew a moral: “The orthopedic surgeons have the duty not only of relieving the patient of physical deformity, but of watching over his mental training during the long periods of hospitalization. The cripple must be made to understand that while his disability can be greatly relieved, he will always carry some slight defect and his chances of success in life can be greatly helped by proper psychological preparation.”

With these preliminaries out of the way, the orthopedists listened to promising means of preventing and remedying bodily deformities, as follows:

Corset Patterns, At Georgia’s Warm Springs Surgeon Michael Hoke invented a clever pattern for the steel-framed corsets which some victims of infantile paralysis wear to keep their spines from growing crooked. Dr. Hoke molds strips of lead to the patient’s body, then fashions steel corset “bones”‘ to duplicate the lead patterns exactly.

Spiked Hips. The unshapely knob at the top of the thigh bone (femur) is the hip bone. When a person, especially if elderly, falls the knob is apt to break off from the thigh bone. Healing has been a tremendously difficult and painful process. Last year Dr. David Robert Telson of Brooklyn suggested piercing the knob and shaft and lacing them together with stout piano wire. This procedure works to a degree. But the stoutest piano wire gives a little. Last week Dr. Frederick J. Gaenslen of Milwaukee said that he got dependable cures of broken hips by nailing the knob and shaft together with steel spikes about half the thickness of a lead pencil.

Shelved Hips. Dislocation of the hip is apt to recur when the muscles which hold the hip bone into the shallow hip socket have been weakened. Injury or infantile paralysis will do this. Dr. Marion Beckett Howorth of Manhattan invented a way of overcoming the slipping of the joint. He cuts through the flesh at the hip, lays bare the joint. Then he carefully breaks the part of the pelvic bone which forms the upper edge of the hip socket. The loosened piece of bone he bends down and wedges securely with bone grafts. After healing, the downturned chunk of pelvis acts like a claw to hold the hip bone within its socket. The new grip is just tight enough to let the leg swing at the hip.

Thigh Brace. Ordinarily two months in bed are necessary before a broken thigh is strong enough to walk on. Dr. Roger Anderson of Seattle gets the patient out of bed in two days by drilling one hole in the femur just above the break and a second just below the break. He puts long steel pins through the holes and flesh and attaches steel braces to the pins. The braces prevent the leg from shortening, permit the patient to walk on crutches.

Shoulder Strap. Once a person has dislocated a shoulder he must ordinarily be careful not to reach too roughly, for probably one-third of dislocated shoulders repeat the accident. Dr. Toufick Nicola of Manhattan prevents the repetition by cutting part of one of the tendons of the shoulder joint (biceps tendon) and drilling a hole through the upper portion of the arm bone (humerus). Dr. Nicola then laces the cut biceps tendon through the hole and fixes it at the other end of the joint. The tendon thus effectively straps the loose joint together.

Fracture & Diabetes. After noting that several of his patients developed diabetes soon after breaking a leg, Dr. Robert Vivian Funs ten of the University of Virginia discovered that every fracture increases the amount of sugar in the blood and that such increase was just enough to make an outright diabetic of a person already on the verge of the disease.

Hips at Birth. Usually it is difficult to know whether a baby’s hip is out of joint. One way to tell is to study the folds in the skin of the thighs. If one thigh is creased more on the inner side than the other, the creased side is dislocated. If both thighs are deeply creased, both hips are probably dislocated. Another method is to put the baby flat on its back and bend its legs at the hips and knees so that its feet are flat on the table or bed. If one hip has been out any length of time, the knee on that side will be lower than the knee of the unaffected side. A careful x-ray picture will also reveal the trouble. But none of these methods shows whether the infant will throw its hip out of joint as soon as it begins to walk.

Last week Drs. Samuel Kleinberg and Herman Solomon Lieberman of Manhattan offered a reliable indicator. On an x-ray picture of the child’s torso they draw a line through the centres of both hips. Then they draw a line through the roof of each hip socket (acetabulum). The angles formed by the roof lines crossing the centre line the doctors call the acetabular index. In normal hips the angles measure between 20° and 27.5°. If the angles exceed 27.5°, dislocation probably will occur.

The roof of the hip socket is gristly and elastic for many months after a baby is born. To overcome congenital dislocation of the hip, the orthopedist need simply spread-eagle the baby’s legs with a brace or v-shaped mattress for about six months. The spread-eagling forces the hip bones into their sockets, which yield enough to make permanent receptacles. If the bracing is done before the child is six months old, he will suffer little inconvenience or pain. In the second six months bones start to become rigid and the operation becomes more difficult and painful. Thereafter manipulation may cause secondary injuries which the orthopedist may well avoid by discreet use of knife, chisel and mallet.