Reprinted from The Pittsburgh Medical Review. 
A Retaining Splint lor Excisions of the Hip-Joint 
WITH A CASE. 
BY STEWART LEROY MCCURDY, M. D., 
DENNISON, OHIO, 
Professor of Orthopedic and Clinical Surgery, Ohio Medical University, Columbus, Ohio; 
Lecturer on Topographical Anatomy and Landmarks, Western Pennsylvania 
Medical College, Pittsburgh, Pa.; Surgeon P., C., C. & St. L Ry. Co. A Retaining Splint for Excisions of the Hip-Joint, 
WITH A CASE.* 
Excision of the hip joint during the active 
stages of the ordinary morbus coxarius is not, 
as a rule, practiced. About 40 years ago 
Sir Wm. Ferguson, as was pointed out by 
Howard Marsh, introduced excision as a 
substitute for amputation in hip joint dis- 
ease. While this operation was not gener- 
ally adopted, it prevented the useless am- 
putation of many limbs. 
With the advances made in conservatism 
and in the mechanical methods of the pres- 
ent day, excisions are very seldom found 
necessary. It is only when there is great 
destruction of bone, associated with extreme 
emaciation, and when such an operation will 
remove from an already vitiated system the 
source of further infection and either prevent 
an immediate death or materially lend to- 
ward the process of repair, and cut short the 
very tedious course of the disease, is such 
an operation justifiable. 
There would appear to be no question as 
to the advisability of an excision in those 
cases where the head of the femur is de- 
tached, or where there was extensive de- 
struction of the trochanters extending to the 
shaft, or where a perforation of the acetabu- 
lum was suspected. 
Dr. Mynter, at the Detroit meeting of the 
American Medical Association, advocates 
the removal of the head of the femur as 
soon as a diagnosis of tubercular disease of 
the head of the bone is made, thus removing 
the primary source of infection, and termi- 
nating a very tedious This will not 
be generally adopted, owing to the fact that 
when hip joint cases are put into the hands 
of those thoroughly prepared to take care of 
them, they, as a rule, run a mild course, and 
recover with a better joint than could follow 
an excision. 
In 407 cases treated by Prof. Sayre, 71 re- 
covered with perfect motion ; 142 recovered 
with good motion ; 83 with limited motion ; 
5 with anchylosis, and only 9 died so far as 
the cases could be traced. 97 of the 407, 
however, were lost track of, and with a 
knowledge of these the statistics might be 
subject to slight revision. From such 
very satisfactory results as is shown by 
Sayre, excision would appear to be unnec- 
essary. 
The mortality after excision, before the 
introduction of antiseptic surgery, was about 
66 per cent, and since strict antiseptic pre- 
cautions have been practiced, the mortality 
rate has been reduced to from 35 to 41 per 
cent. Under present methods this death 
rate has been materially reduced below the 
above showing. 
The case under consideration, aged 12 
years, fell on the ice in February, 1889, the 
force of the fall being received by the right 
trochanter major. Shortly after she began 
to have pain in this hip, which gradually 
grew more severe for a number' of months. 
About 6 months after the reception of the 
injury, the characteristic tubercular abscess 
appeared upon the outer aspect of the thigh. 
About 12 months after the appearance of the 
abscesses, they opened spontaneously at a 
number of points. These sinuses continued 
*Read before the Stillwater Medical Society, at Cadiz, Ohio 3 
to discharge, the structures about the hip 
were thickened, and the infiltration was ex- 
tensive. 
During this time she was confined to bed, 
but after the exit for the liquid products of 
disease had been established by the forma 
tion of the sinuses, she was able to get about 
on crutches. I saw the case first in May, 
1892, with Dr. Brannan. The Doctor had al- 
ready concluded that an excision was neces- 
sary, and had gained the consent of the pa- 
rents. The usual incision was made and the 
head of the femur turned out. Not only the 
head of the bone «was diseased but the neck 
and trochanters, which were removed below 
the trochanters at a point that was thought 
remote enough from the original seat of the 
disease to include all the diseased structures. 
The upper end of the shaft, however, was 
also found diseased, requiring the removal 
of a portion of the shaft. 
Instead of extending the incision already 
made, the diseased member was thrown 
across the well thigh and the bone peeled 
out of its periosteum and pushed through 
the wound until healthy bone was thought 
to be found, when it was sawed off. 
The acetabulum was also found diseased, 
and perforated so that the point of the fin- 
ger could be pushed through into the pelvic 
cavity. The diseased surface upon the 
acetabulum was thoroughly curetted with a 
Volkman spoon until healthy structures 
were thought to have been found. The sin- 
uses, which were found to be very extensive 
in the soft parts, were all curetted with the 
Volkman spoon. After washing out the cav- 
ity with bichloride of mercury, 1-2000, the 
wound was drained and closed. 
Alter the excision the patient was done 
up in plaster of Paris from the thorax to 
the calf of the leg-the plaster being rein- 
forced by a piece of iron from the anterior 
superior spine to near the knee, along the 
anterior surface of the joint. While the 
plaster was drying, traction was made so as 
to prevent shortening of the limb. 
Owing to the extent of the operation, the 
patient suffered considerably from the shock, 
but rallied promptly and permanently. 
Measurements were taken for a brace, in 
view of keeping the hip in bed (practically) 
and allow the patient to go about. 
I had constructed for her the splint shown 
in the photographs and which is shown in 
the model. As you see, it is made of a 
perpendicular piece of iron, extending from 
over the posterior portion of the hip and 
along the back part of the diseased member, 
terminating in three prongs opposite the 
tendo achilles. These prongs extend down 
to a steel foot piece which serves as a walking 
support. A horizontal thoracic band is 
secured to the upper end of the perpen- 4 
dicular bar over the scapula. Another half 
circle is placed below the knee. A perineal 
horn is placed so that it will fit snugly 
around the thigh under the tuber ischii and 
pubic arch. This is to receive the weight 
of the body. 
The perineal horn is made to continue 
around posterio-externally to a point over 
the anterior superior spine. This piece is to 
support the anterior superior spine and thus 
prevent flexion. As it hugs about the pelvis 
upon the affected side, it also prevents ab- 
duction. 
Traction is made from the foot plate by 
leather straps which are buckled to the usual 
lateral adhesives. In case elastic traction is 
desired, the same can be accomplished by 
securing the upper end of the elastics to the 
lateral adhesives and the lower ends to hooks 
that can be made to project from the foot 
plate. These straps should be kept buckled 
very tight so as to prevent shortening of the 
leg, which will necessarily follow after the 
removal of four inches of the femur's length, 
unless it is held in the normal position 
mechanically. The foot plate is made so as 
to be from one to two inches below the 
bottom of the foot, and this is compensated 
for by a patton of equal thickness on the 
other foot. 
The specimen as seen in the photo is of 
exact size. It is just four inches from the 
point of the greater trochanter to the lower 
end of the bone. 
The brace was adjusted three weeks after 
the operation and the patient got out of bed 
and has been walking about ever since with 
no pain, no fever, and a decided improve- 
ment in her general health. The splints 
take the place of a bed for the excised joint, 
as well as doing away with a pair of crutches, 
which would otherwise have to be used. 
The original focus of tubercular deposit 
was evidently in the head of the femur. The 
head shows a general " worm eaten " ap- 
pearance, characteristic of tubercular dis- 
ease of bone. 
It will be observed that the superior 
portion of the head is worn away, even be- 
low a level with the superior boundary of the 
neck of the femur. This shows that the 
muscular spasm was sufficient to produce 
enough pressure to promote the absorption 
of this portion of the head of the bone. 
A second focus of tubercular infection is 
shown upon the outer and posterior aspect 
of the greater trochanter. 
The cavity shown is of a cone shape, and 
the sequestrum found at this point was small 
and of the cheesy variety.