way upon the skin, and thus does not cause tension upon the adductor tendons. This tension upon the tendons of the adductor muscles, which is a certain accompaniment of the disease when treated by splints possessing a perineal band which comes in contact with the skin, does not occur, and the increased reflex spasms caused by the pressure of the perineal band, and which cause an apparent shortening of the limb, are prevented. The sector joint is always opposite the hip joint in whatever position the patient may be, and the amount of extension also remains the same in every position. By the use of this splint we take the weight of the body off the joint, and by making the sector do its work, the joint is given true physiological rest. A detachable jointed rod may be passed down to the centre of motion of the foot where it can be attached by a pivot to the shoe, and elastic power properly placed to allow the foot to be inverted or everted at will. (Fig. 9.) KNEE-JOINT. For the knee two sectors are usually required-one upon each side of the joint (Fig. 10); and, if the patient must be upon the limb considerably, it is usually better to pass a rod, jointed at the ankle, to the centre of motion of the foot where it is pivoted, and thus fix the attachment below the knee unalterably and still allow free movement of the foot (Fig. 11). It is necessary in all Fig. 11. cases to fix the attachment below an affected joint unalterably, i. e., so that it cannot be pushed away from the joint by any extension power used, so that the weight of the body above the joint may be lifted away from it by the extension bar of the splint, and the motion of the joint, which is necessary to health, not be complicated by pressure, which is injurious in disease. There are several points or surfaces which can be connected to the attachment below a joint to render it firm. For the lower extremities, this is the centre of motion of the foot.1 For the trunk, the pelvis; and for the arm, the hand. ANKLE-JOINT. For the ankle, the splint is constructed as shown in Figs. 12 and 13, and is very serviceable. It is attached inferiorly to a sole of leather or felt moulded to the plantar surface of the foot, 1 See Transactions of the American Medical Association, 1880. and bound down with some firm dressing. It allows motion, and yet removes all undue pressure from the articular surfaces, and will be found of use in all varieties of injury or inflammation in or about this joint. For the elbow, the sectors are somewhat smaller than for the knee, and in general the same form, made small in proportion, is used for the smaller articulations. With regard to the use of the sector in fractures, simple and compound, I cannot as yet speak from an extended experience; but in a modified form, adapted to the limbs (see Fig. 14), it seems probable that it may prove a most reliable agent, especially in those cases where exposure of surface, gradual reduc tion of deformity, and the effects of local extension generally are desired. Fig. 15 shows its probable application to the thigh. Fig. 14. Fig. 15. In conclusion, let me state that I have tried to outline in as brief a manner as possible, the essential points of this new system of surgical mechanics; but that much is necessarily omitted which is necessary to the proper understanding of the subject. It has, however, progressed to a degree in its development which encourages us to believe that the sector splint will eventually be recognized as one of the most valuable mechanical agents which the surgeon can have at his command. |