[Reprinted from the Transactions of the Medical Society of the State of New York, 
February, 1890.] 
THE PENDENT LIMB IN THE TREATMENT OF JOINT 
DISEASES OF THE LOWER EXTREMITY. 
By A. B. JUDSON, M.D., 
NKW YORK. 
The following figures, drawn from the last annual reports of tVo 
orthopedic institutions,1 illustrate an interesting fact, contaiu an 
important pathological doctrine, and enforce a practical lesson : 
Cases of Articular Osteitis. 
Hip, 558; 
Shoulder, 7; 
Knee, 207; 
Elbow, 16; 
Ankle, 64 = 829. 
Wrist, 3 = 26. 
It appears that iu a single year 829 cases of disease occurred in 
the large joints of the lower extremity, while 26 cases occurred iu 
corresponding joints of the upper extremity. 
That this disproportion exists is a most interesting fact, one that 
has been under our eyes year after year and only lately properly 
recognized and emphasized. The pathological doctrine embodied 
is, that inflammation of the bony structures of a joint is readily and 
spontaneously resolved when favorably situated, as in the upper 
extremity, where the part affected is absolutely exempt from the 
violence which falls ou the structures of the lower limbs in stand- 
ing and in locomotion. The practical lesson is the precept that in 
the very earliest iucipiency of disease of any of the joints of the 
lower extremity the weight of the body should be taken off from 
the affected limb until the inflammation is resolved, though it may 
take months and years. By the arts of mechanical surgery the 
affected member should be made constantly pendent and as little 
liable to strike the ground or receive the corporal weight as the 
arm, which swings free in locomotion and has never known the 
burden of the weight of the body. 
What application of mechanical or orthopedic surgery can be 
’ The New York Hospital for the Ruptured and Crippled, and the New York Ortho- 
pedic Dispensary and Hospital. 2 
A. B. JUDSON, 
bast made for this purpose? Crutches and a high sole on the well 
foot are a ready solution of the problem ; but consider the diffi- 
culties, the chief of which is found in the fact that the patient, usu- 
ally a child, will lay crutches aside, and no amount of persuasion 
or discipline can keep them in use during the long periods in which 
the general health and freedom from pain obscure the serious nature 
of the affection. 
This difficulty disappears with the use of the simple device known 
as the perineal or ischiatic crutch, which retains its place without 
the aid of the hands and under the clothing. That its use leaves 
the hands and arms free and that it is inconspicuous give it a great 
advantage over a pair of crutches, but its chief superiority lies in 
the fact that by its use the weight of the body falls on the ischiatic 
tuberosity, a part of the anatomy which is accustomed to bearing 
the weight in the ordinary sitting posture. The anatomical features 
of the axilla are but little adapted for sustaining such a weight. 
The loose joiut which the shoulder makes with the trunk, and the 
pressure, in just the wrong place of the brachial and axillary vessels 
and nerves, make the use of a pair of crutches sometimes painful 
and generally awkward. 
When we consider, on the other hand, the solidity of the union 
between the os iunominatum and the vertebral column, the basic posi- 
tion of the os iunominatum in the skeleton of the trunk, and the fact 
that it is designed to bear, and most of the time does bear, the weight 
of the greater part of the body in sitting, standing, walking, and 
running, it becomes clear that here, if anywhere, should be applied 
an artificial support for the relief of the disabled lower extremity. 
The ischiatic crutch, described1 and exhibited on previous occa- 
sions, with its perineal strap applied to the tuberosity and ramus 
of the ischium, is absolutely simple in its construction and fully 
insures a pendent limb, whether the joint to be protected is the hip, 
knee, or ankle. 
It does not interfere with the ordinary activities and avocations 
of childhood, and it is practically easy with this instrument to obey 
the precept above referred to in regard to making the limb pendent 
from the beginning to the resolution of articular osteitis. 
Two or three practical points should be attended to. The upright 
should be strong and light, and these qualities may be secured by 
1 The Medical Record, July 2, 1881, June 2a, 1887. JOINT DISEASES OF LOWER EXTREMITY. 
3 
a single perineal strap, which brings the weight of the body more 
directly over the supporting column which is the upright portion 
of the apparatus. The pelvic band should be worn at a level below 
the anterior iliac spine and above the trochanter, a position which 
may be maintained if a short perineal strap be used. 
At the lower end of the apparatus it will be noticed that there is 
a wide departure from the ordinary arrangement of feet and shoes. 
On the affected side the splint and not the foot reaches the ground. 
I have found the method of shoeing the splint which is shown in 
the cut both convenient and economical. If sole leather of the very 
best quality is used it lasts a long time and the expense is small. 
On the well side the necessity of a high sole has been the cause of 
vexation and expense, both of which I have partially avoided by 
the use of a wooden sole, or sabot, constructed and fastened on with 
screws in the manner shown in the cut.