-a^ G^u^-^-a'l. 
Hip-Injuries, including Hip -Joint Disease, and Fractures 
of the Femoral Neck, Splint for. 
Read before the Philadelphia Academy of Surgery, June 7,1880, 
BY 
DE F. WILLARD, M.D., 
Lecturer on Orthopedic Surgery in the University of Pennsylvania. 
REPRINTED FROM THE PHILADELPHIA MEDICAL TIMES, NOVEMBER, 1880. HIP-INJURIES, INCLUDING HIP-JOINT DISEASE. AND FRACTURES 
OF THE FEMORAL NECK, SPLINT FOR. 
I desire, in connection with the exhibition of the accompanying 
splint, not only to call attention to its adaptability to ununited or 
badly-united intracapsular fractures of the femur, but also to recom- 
mend it as an exceedingly useful support in the disabilities follow- 
ing sprains, lacerations, twists, and dislocations (congenital or 
traumatic) of the coxo-femoral articulation. Of its use in hip- 
joint disease, I would say here that it is of the greatest advantage in 
non-acute cases in the first stage, and in the majority of patients 
during the other stages. 
I have for several years been in the constant habit of fixing this 
joint in fractures of the upper portion of the thigh, and in all hip- 
injuries and diseases, by permanent dressings of binders' board, 
starch, felt, plaster of Paris, silicate of soda, etc., especially in the 
case of children ; but the great inconvenience-in fact, the impossi- 
bility-of sitting while encased in one of these dressings, if prop- 
erly applied,-i.e., so as to embrace the thorax,-did not force 
itself upon my mind until I was obliged personally to resort to the 
use of such a dressing for the disability following a laceration of 
the ligamentum teres caused by a violent twist of the leg. 
One has but to try the experiment to find that a position other 
than standing or lying is absolutely incompatible with comfort or 
the power to pursue any ordinary avocation. 
I had often wished to make a joint in my hip-disease dressings, 
especially in adults who were obliged to attend to business, but, 
although familiar with the use of leather and felt for spinal dressings, 
it had not occurred to me to apply them to the hip until I chanced 
to see a leather apparatus for the relief of a paralytic trouble. 
1 2 
The difficulty with an ordinary jointed splint, however, was that 
it would not put the hip perfectly at rest ; and I accordingly 
had Mr. Gemrig make me the steel joint which you see here, 
and which can be locked and unlocked at pleasure, thus rendering 
the hip perfectly fixed until just at the moment of sitting, when by 
lifting the bolt (which can be easily done through either a gentle- 
man's or lady's clothing) a perfectly movable joint is secured. 
The method of constructing this apparatus is first to make a 
mould, by plaster of Paris bandages, of the body as high as the 
lower angle of the scapulae behind and the point of the ensiform 
cartilage in front, in order to secure a firm thoracic support; thence 
downward, covering in the pelvic region as low posteriorly as the 
commencement of the internatal crease and anteriorly to the sum- 
mit of the pubis; thence over hip, buttock, and thigh to a point 
about three inches above the knee-joint. This mould can be best 
taken over a light pair of bathing or other closely-fitting drawers. 
When thoroughly hardened, it is to be slit up, removed, and from 
it can be made a plaster cast which will be the exact shape of the 3 
individual to be fitted, every point and irregularity being repre- 
sented. 
Upon this cast wet leather is stretched and rubbed and worked 
until it exactly conforms itself to the surface, when it is allowed to 
dry in situ, the result being a perfect fit. 
This leather is so tanned by Mr. Gemrig that, while it is exceed- 
ingly light, it is perfectly hard and tough, being much better than 
sole-leather or raw hide. 
The above process, though somewhat costly, gives a most beauti- 
fully fitting apparatus, but I believe that, as the splint is to be worn 
outside of underclothing, a sufficiently accurate splint might pos- 
sibly be secured by simply applying the wet leather directly to the 
person of the patient, shaping it, and allowing it to remain in 
place a short time until it had hardened just enough to retain its 
conformation, thus avoiding both the plaster mould and the second 
cast, and saving considerable expense. The first-mentioned plan, 
however, is by far the better one. 
When thoroughly dry, the body and thigh portions are separated, 
and connected by a joint attached to two spreading steel arms, as 
seen in the drawing. 
This joint must be a strong one, and should be made double,- 
i.e., not with a simple rivet, but by the same process as is employed 
in the manufacture of artificial limbs. 
In the lower section is a mortise or slot (a) into which fits the 
bolt (ty, worked (through the clothing) by the head (r), and thus 
perfect fixation is secured. 
This bolt slides easily through the eyelets (/Z, <?), and is retained 
in its place when lifted by a spring pressing like a finger against 
its side. The unlocking can be done in a second, during the act 
of sitting down. The whole splint is perfectly simple and can 
hardly get out of order. It is to be laced down the front of the 
abdomen and thigh. 
The steel thigh-pieces could be united into one and continued 
down to the shoe; but, even though this be done, I consider the 
enveloping thigh-band as one of the essentials for fixation. 
The numerous openings (/, g, h) render the apparatus lighter and 
give slight vent for exhalations. The total weight for a man weigh- 
ing two hundred pounds is but forty-five ounces. 
The joint allows only the hinge-motion, a matter which is of 
decided advantage in twists or lacerations, and also in hip-disease 
where the round ligament is involved, as rotary and lateral motions 
would tend to prevent the needed repair. 
To render the apparatus comfortable, it is necessary to cut away 
certain portions after the patient has worn it, especially the part in 4 
front beneath the ribs and above the groins. This can be narrowed 
down greatly so as to give comfort in sitting, for as the leather is 
stiff all necessary support is gained by the broad posterior portion, 
which embraces pelvis and thorax. The edges can then be padded 
with curled hair over salient points, and it will be found that greater 
ease is obtained by taking the weight off the hips by means of sus- 
penders over the shoulders. 
When locked, it is surprising how the weight of the body is 
transferred to the thigh through the medium of the steel without 
any strain upon the natural joint. 
In the disabilities following injury I can testify that it is of the 
greatest service, and I have also found it of marked benefit as a sup- 
port in the late treatment of morbus coxarius, enabling fixation or 
mobility as desired, and so taking off weight from the impaired joint- 
structures that the crutches can be dropped at a much earlier period 
than would otherwise be safe. 
It is applicable to a large number of hip-disease cases,-i.e., those 
in whom the inflammatory symptoms are not acute, in either first, 
second, or third stage. It should always be used, of course, in con- 
nection with the plan of crutches, and a high shoe upon the sound 
foot, thus securing extension. Used in this combination, I believe 
that it furnishes all the desirable points to be gained in the treat- 
ment of this terrible disease, since, while it gives absolute fixation 
at will, it also allows the patient to go about his ordinary out-door 
pursuits on crutches and yet to sit at comfort. All hip-disease 
splints do good chiefly by fixation, and there is not one which is 
effectual if the weight of the body is thrown upon the limb. 
To supply the lacking power of steadying the pelvis upon the 
thigh in cases of fracture of the femoral neck, and in instances of 
congenital dislocation of the head of the thigh-bone, I believe this 
splint offers great hope, although I have not, as yet, had opportu- 
nity of testing it, and, of course, the future alone can decide. 
1626 Chestnut Street.