A Practical Splint for Inflammatory 
Conditions of Joints. 
— BY — 
CHARLES F. STILLMAN, M. Sc., M. D., 
Chicago. 
Member of the American Orthopoedic Association. 
REPRINTED FROM AMERICAN LANCET, 
MARCH, i89o. [REPRINTED FROM THE AMERICAN LANCET, MARCH, 1890.J 
A PRACTICAL SPLINT FOR INFLAMMATORY CON- 
DITIONS OF JOINTS. 
BY CHAS. F. STILLMAN, M. SC., M. D., OF CHICAGO, ILL. 
(FORMERLY OF NEW YORK CITY). 
AT the meeting of the American Medical Association 
in 1881, the writer presented to the Surgical Sec- 
tion a new joint splint which possessed the following 
advantages: 
1. Extension at any angle with motion. 
2. Extension at any angle with fixation. 
3. Fixation at any angle. 
4. Motion, complete or limited. 
5. Exposure of surface about the joint, allowing 
compression (elastic or otherwise), hot and cold applica- 
tions, blisters, dressings, without disturbing the action 
of the apparatus. 
FIG. i. 
Stillman’s Sector Bracket. 
This splint, to which I gave the name of the sector 
bracket (see Fig. i), consists of two terminal plates of 2 
thin copper, perforated upon the upper side, connected 
with each other by a sector bridge, slightly raised above 
the plane of the terminal plates. This bridge consists 
of two over-riding slotted steel strips, connected by three 
clamps. 
This bracket may be most expeditiously secured to 
a limb with plaster-of-Paris bandage, or a combination of 
adhesive plaster and plaster-of-Paris, and when dry, the 
joint can be kept by it under perfect control. 
For example, suppose the knee to be the joint for 
which the sector splint is to be applied. (See Fig. 2). 
The thigh portion of the attachment 
forms the segment of a hollow in- 
flexible plaster cone which has firmly 
grasped the muscular structures 
above the joint, and any extensible 
force which pushes this segment 
away from the lower or tibial seg- 
ment acts in direct antagonism to 
the inherent strength of the thigh 
muscles, and stretches the tissues be- 
tween the attachments, thus caus- 
ing these tissues to assist in pro- 
tecting and fixing the joint, because 
of the rigidity they are made to as- 
sume by the stretching process. 
In order to successfully produce 
local extension of a joint, the attach- 
ment below the articulation should 
be fixed immovably, and the exten- 
sion force should be exerted in the axis of the limb, and 
thus directed against the contractile resistance of the 
muscular mass governing the joint, until this is overcome 
and rest thereby produced. 
The sector joint fulfills these indications perfectly, 
Showing application 
of sector bracket to 
knee. 
FIG. 2. 3 
and has proved itself since the time of its introduction 
of especial service in the treatment of various acute in- 
flammatory conditions of the joint. It is also without a 
rival in the after-treatment of anchylosis and exsections 
of the joints, owing to the change of angle it permits, 
while extension is maintained. 
It has received warm commendations from many 
distinguished surgeons, and as the same bracket, or 
pair of brackets, can be employed for any of the larger 
joints, it possesses a wide range of usefulness, and can 
be used over and over again in successive cases, being 
practically non-destructible. 
But in chronic knee-joint disease, a plaster-of-Paris 
dressing is uncomfortable, and cannot be removed with- 
out more or less disturbance of the joint—and since the 
atrophic changes in the muscles render frequent changes 
of plaster-of-Paris dressings a necessity—the writer has 
since devised for such cases special forms of apparatus; 
and the remainder of this paper will be devoted to a 
description of the form of brace,—see fig. 6,—which I 
have found most useful in the various chronic inflam- 
matory conditions of the knee. 
The treatment of diseases of the knee-joint as a 
class have, from a mechanical standpoint, been impeded 
by the difficulty in procuring apparatus which could be 
used advantageously through all stages of treatment and 
in every possible condition which might arise during 
such treatment, and there has been no one splint which 
would meet all the different mechanical indications. 
One of the most important of these indications is to 
incorporate in the brace, and to place on either side of 
the joint (in its transverse pivotal axis), a movement 
which will allow either fixation or motion. In fig 3 such 
a one is shown,* and if the pivotal centre is placed in 
* For description of this movement, see the Boston Medical 
and Surgical Journal, August 31, 1882, page 200. the transverse pivotal axis of the joint, its arc of 
motion will correspond closely to the arc of motion in 
the normal joint, and by means of the clamp in the 
slotted arc, the joint may be fixed in any desired posi- 
tion, or by releasing the clamp slightly, 
motion may be allowed. 
Another important indication is the 
occasional employment of traction, and 
a new feature in this splint consists in the 
method of obtaining it by having adhe- 
sive plaster grasp the knee just below 
and above the joint over a very limited 
area; and to effect this the plaster is cut 
in the fan shape, shown in fig. 4 (A), and 
long strips of webbing are attached to 
each. It requires four of these fan- 
shaped pieces for each knee, and four 
long pieces of webbing, and these are to be placed as 
shown in fig. 4 (B), interlaced for greater security from 
displacement, and then covered with roller bandage as 
in fig. 5. Upon the superior and inferior extremities of 
the splint are provided rollers and buckles, to which the 
webbing is to be attached, and then, by means of an 
elastic rachet, force may be applied upon the thigh por- 
tion of the instrumeut to effect the extension (see fig. 7). 
This arrangement differs from any attachment in 
ordinary use at the present time, in being limited to a 
small zone just above and below the joint, and conse- 
quently does not interfere with the muscular structure of 
the thigh or leg, as is the case when the splints are ap- 
plied by adhesive plaster over the whole extent as in 
other splints for this purpose, or in the former plaster-of- 
Paris attachment of the writer. 
To exert the traction and produce extension of the 
4 
Stillman’s joint 
movement for 
fixation or 
motion. 
FIG. 3- joint, the ends of the webbing strips are to be passed 
over the rollers at each extremity of the splint, and after 
being pulled upon as firmly as possible and secured in the 
buckles provided for that purpose. The upper girth is 
5 
fig. 4. 
FIG. 5. 
(a) Fan shaped pieces of adhesive 
plaster, with webbing attached, for 
traction. 
(b) The same applied to limb, in- 
terlaced. 
(1c) The same cov- 
ered with roller band- 
age, ready for the 
splint. 
then pushed away from the remainder of the apparatus, 
either by elastic or rigid ratchets, as the surgeon pre- 
fers. The ratchets shown in figs. 6 and 7 consist of two 
overriding slotted strips, which can be fastened together 
by a screw clamp when sufficient traction has been ex- erted by the elastic strap provided for that purpose. 
This form of ratchet is more effective than any other form 
of traction ratchet in use, because by simply loosening or 
tightening the clamp (the elastic strap being on the 
stretch at the same time), the traction may be varied 
from the elastic to the fixed at the will of the surgeon. 
A point of the utmost importance in the treatment 
of knee-joint disease, is the prevention of posterior luxa- 
tion. Most of the diseases of the knee-joint are accom- 
panied by a tendency, even in mild cases, to luxation 
of the tibia backward, and this is a feature which ortho- 
paedic surgeons have tried to overcome. To meet this 
indication, the writer has devised an effective arrange- 
ment which brings to bear a spring lever power, distinct 
from anything heretofore used and which operates with- 
out interfering with the action of the remainder of the 
brace. It will be noticed that it consists of a long, flat 
metal bar, bent to conform to the shape of the back of 
the leg and placed posteriorly (see fig. 6). At its upper 
end is attached a semi-girth which presses on the back 
of the upper part of the leg and below it is attached to a 
stirrup which is itself fastened to the lower girth of the 
instrument. 
This stirrup is provided with a hinge and socket, so 
that it may be opened and shut when the rest of the 
brace is in position, and the forward pressure, which is 
dependent upon the angle which the posterior lever 
makes with the rest of the brace can thus be adjusted by 
means of a ratchet at the intersection of the lever with 
the stirrup, without the necessity of removing the brace 
from the limb. 
One of the features of this arrangement, consists in 
its adaptability for all classes of cases in which the least 
tendency to this subluxation exists, for it can be adjusted 
to any desired angle, thereby giving any degree of for- 
6 ward power, and this power is brought to bear precisely 
where it is wanted without causing impingement of the 
brace upon the limb at any point. 
7 
Stillman’s knee splint. 
fig. 6. 
Still man’s knee 
splint applied. 
fig. 7. 
There are very few cases of joint disease, even of 
the simplest form and the most recent date, in which the 
comfort of the patient is not increased by having a 
degree of forward pressure exerted just below the pop- 
liteal space. 
By means of a ratchet at the intersection of the in- 
ferior extremity of the posterior lever and the stirrup to 
which it is attached, this power, as has been stated, can 
be adjusted so that the lever can be varied from a 8 
mere upright support to a spring lever of tremendous 
force, and in every case in which it has been applied 
(provided of course, that the power exerted is not be- 
yond the amount necessary for the particular case) the 
patients usual comment is to the effect that the comfort 
of the apparatus is thereby much increased—and from a 
surgical standpoint the joint is placed in much better 
condition for curative treatment, because this tendency 
to backward luxation is thereby greatly overcome. This 
is but another application of the V-shaped lever which 
the writer is using in the treatment of diseases and de- 
formities of various portions of the body. 
In conclusion, after the traction has accomplished 
its purpose, and extension of the joint is no longer 
necessary, this chronic joint brace is so arranged as to 
permit the removal of the rollers and buckles at each ex- 
tremity and of the traction ratchets, thus converting it in- 
to an effective fixation brace or knee support during con- 
valescence, and when by the use of restorative measures 
the anterior muscles of the thigh have been strengthened 
so as to hold the tibia forward in its normal relation with 
the femur—the V-shaped lever may be dispensed with— 
provision for that purpose being made without impairing 
the efficacy of the rest of the brace. A description of 
the means to be employed for the restoration of these 
muscles constitutes too important a subject to be dis- 
cussed within the limits of this paper and will be reserved 
for some future occasion; but the neglect of this pre- 
caution is not only a fruitful source of the long continu- 
ance of lameness after cessation of all actual disease in 
the joint, but is a cause of relapse, and the importance 
of muscle restoration is too little insisted upon by ortho- 
paedic writers when considering the subject of chronic 
knee-joint disease. 
125 State St,, Room j6, Chicago, 111.