AN IMPROVED FRACTURE-BOX 
For the Repair of Injuries of the Lower Extremities Requiring 
Extension and Counter-extension. 
BY 
JOHN B. BROOKE, M.D., 
of reading; pa. 
FROM 
THE MEDICAL NEWS, 
June 16, 1894. [Reprinted from The Medical News, June 16, 1894.] 
AN IMPROVED FRACTURE-BOX 
For the Repair of Injuries of the Lower Extremities 
Requiring Extension and Counter extension. 
By JOHN B. BROOKE, M.D., 
OF READING, PA. 
There is, perhaps, no more successful method of 
treating fractures of the lower extremities in their con- 
tinuity than by the ever-ready sand-bag, pulley and 
weight, which have largely supplanted the more pre- 
tentious measures adopted years ago, including the 
various appliances for extension and counter-extension 
from the axilla and perineal appliances, which were 
always more or less painful, difficult of adjustment, par- 
ticularly in compound injuries, and always tedious to 
be borne for any great length of time. Whilst, however, 
this apparatus answers the purpose for which it is em- 
ployed, and generally effects most admirable results, it 
is nevertheless, by its size and weight, inconvenient to 
handle, requires frequent adjustment, and, in hot 
weather, adds greatly to the warmth and discomfort of 
the patient, necessarily increasing nervous irritability 
and restlessness, and, as a consequence, protracting the 
recovery. Besides, to make the treatment effective, the 
sand-bags on the inside and outside of the limb must 
be firmly adjusted and strapped to it above and below 
the knee. Holding it thus in a vise as it were, exten- 
sion is made along the leg, but not always with success, 
for no one who has had much experience with this form of 
dressing can fail to recall many instances in which it was 
almost impossible to keep the foot from deflecting to one 2 
side or the other. To this objection, too, must be added 
that of increasing greatly the weight of the extremity 
by the attachment to it of the bags, and necessarily re- 
quiring increased weight to effect the desired extension. 
This excessive weight, besides producing abrasions of 
the instep and heel, with the attendant pain and sore- 
ness, adds, also, to the strain upon the adhesive strips, 
creating irritation beneath them. There is a still further 
objection. By the combined weight of the sand-bags 
and limb, the bed, unless a very hard one, will, immedi- 
ately under them, become so much pressed down into a 
hole, if you please, that it will act as an obstacle to the 
sliding forward of the leg and the consequent separation 
of the fragments. 
To do away with the objections to the use of the sand- 
bags in whole or in part, I present to the profession an 
improved fracture-box, which I devised some months 
ago whilst treating an intra-capsular fracture of the 
femur. It has been in very successful use since then. 
It presents the following advantages over the sand-bag 
treatment: It is, under all circumstances, easily adjusted 
to the injured limb; it is not hot and confining; there 
is less pain and uneasiness in extension in consequence 
of less than one-half the weight being required by its 
use for a given amount of traction ; injuries are readily 
examined, and above all, the surgeon has perfect con- 
trol of the position of the limb. 
In the construction of the box little skill is required, 
the only care demanded being in the proper selection of 
well-seasoned wood, particularly for the piece on which 
the box proper rests and rolls. Unless this is of the 
best material it will warp, and prevent the easy to-and- 
fro motion of the box, upon which the success of the 
whole apparatus depends. I may add that the bed upon 
which the patient rests should be of hair, and the bed- 
stead at least one foot longer than those usually made 
for hospital use. With these precautions the fracture- 3 
box will always be firm, and the traction upon the limb 
at the best. 
This improved fracture-box consists essentially of two 
parts. The first, as shown by Figs. I and 2, is nothing 
but a flat board, 8 x 22 inches, and a half-inch thick, 
Fig. i. 
guarded on the long sides by a strip one-quarter inch 
thick by one inch broad (a, Fig. 1), to keep the box 
properly in place and to allow it to move freely on its base. 
This latter is perforated in its center by a slot, b, six 
Upper aspect of track. 
Fig. 2. 
inches long, and wide enough to admit of an inch screw 
(c, Fig. i), which, entering a little block of lignum vitae 
(d, Fig. 3), confines the box loosely to the base. This 
latter, at its back end, is slightly bevelled, to afford 
greater ease to the limb. The box proper (Fig. 3) con- 
sists of three pieces, viz., a bottom board one-half an 
Inferior aspect of track. inch thick, and large enough to run easily within the 
sides of the base. This is also bevelled, as seen at e 
(Fig. 3), in continuation of the base, and is perforated 
by four openings for rollers, 1, 2, 3, 4. The front end 
4 
Fig. 3. 
View of fracture-box, open. 
has a circular opening two inches in diameter, which is 
covered rather loosely by a piece of chamois leather, 
and surrounded by a hair cushion, f, of the same 
material, to receive the heel and thus enable it to move 
the box when the weight is applied to the leg. The sides 
of the box are 5 by 19 inches, hinged to the bottom 
board and notched at the base, as at g, G, G, to admit of 
the passing of the straps to confine the limb. As these 
sides sustain the whole inward pressure of the straps, 
there are small blocks (h, h, h, Fig. 3), firmly glued to 
them to antagonize this force. At the top of the sides, 
and on a line with the lower notches, are similar ones to 
keep the straps in position and to receive the turned 
pins, 1, I, 1, made of steel or brass, which hold the straps 
and thus do away with the use of hooks or buckles. To 
avoid the pinching of the skin when the box is drawn 
back, a doubled strap of chamois leather is placed on 
the bevelled edge (j, Figs. 3 and 4). The posts, k, k, firmly fastened to the front of the sides of the box, are 
topped by pieces of copper-pennies, answer an excellent 
purpose-turning eccentrically about a screw, so that 
the guiding strap of the foot (l, Fig. 4), may be removed 
at will without opening the buckle. 
5 
Fig. 4. 
View of fracture-box, extended. 
The straps are of soft leather, perforated at one end 
by one hole the size of the pins, and at the other by a 
number to admit of proper adjustment. Over each of 
these a pad slides so that pressure upon the limb can be 
applied when desired. 
The play of the box is six inches, as indicated by the 
length of the slot in the base. In conclusion, I may 
add that the free ends of the traction plaster-strips pass 
around a segment of a ball 2 by 3 inches, the eyed screw, 
to receive the hook of the extension cord (m, Fig. 4), 
passing through the plasters, and into the ball, thus con- 
fining them the more firmly. The Medical News. 
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