Fig. 76.—Radiogram of Steinmann's Apparatus applied for Direct Extension to the Femur.
Hodgen's splint is a comfortable and efficient means of treating these fractures, as it allows the patient a certain amount of movement, admits of the part being massaged, and facilitates nursing.
It consists of a wire frame ([Fig. 77]) to one side of which a series of strips of flannel about 4 inches wide are attached. Extension strapping is first applied, and then the frame, which extends from the level of Poupart's ligament to well beyond the sole, is placed over the front of the limb, and the loose ends of the flannel strips brought round behind the limb, and fixed to the other side of the frame, convert it into a sling. The tapes attached to the extension strapping are now tied to the end of the frame. By suspending the limb in this splint by means of cords passing obliquely over a pulley attached to an upright at the foot of the bed, the weight of the limb is made to act as the extending force.
Fig. 77.—Hodgen's Splint.
The retentive apparatus should be worn for from six to eight weeks, after which the patient is allowed up with crutches, which he usually requires to use for three or four weeks longer, before he can bear his weight upon the limb. The old dictum of Nélaton, that the treatment of fracture of the thigh should last for a hundred days, is a safe working-rule. In fractures of the shaft an ordinary Thomas' knee splint, or a “walking calliper splint” which is fixed to the heel of the boot, may be worn when the patient gets up.
Union may be exceedingly slow in fracture of the femur, and may even be delayed for months. Mal-union sometimes occurs, the fracture uniting with an angular deformity outward and forward.