tion of the pound every instant upon the spring scale in the suspending cord. Movements of the patient in Hodgen's suspension do not cause sudden interruption of the extension force, as in Buck's extension. One should think of the extension force as a pull acting from a fixed centre, the pulley-wheel in the ceiling, along a radius, the pulleycord and the patient's limb, upon a movable point, the pelvis. So long as the pelvis moves only in the circumference or arc limited by the width of the bed, the pull is not appreciably influenced. Thus the patient can turn in bed, sit up, lie down, assist himself in many ways, without disturbing either the extension force or, as obviously follows, the coaptation of the fragments, because the pull holds the fragments in position. Any motion produced by the patient's activities occurs, not at the seat of fracture, but at the hip-joint. Not so in Buck's extension. Every move disturbs the fracture, as is forcibly evident in the patient's outery. The fact that the patient in Buck's does not remain immovably fixed, as would be theoretically necessary, but really moves or is moved many times a day, proves that absolute immobility of fragments is not essential to union. Indeed, it is considered better in most fractures that a degree of mobility within reasonable bounds be encouraged as a natural stimulus to bony union. Still, it is obvious that any sudden, complete relaxation of the extension force in the earlier days of treatment tends to overlapping or angulation, with shortening of the limb, as so frequently happens, despite all precautions, when Buck's extension is employed. Yet, in order to properly attend to toilet and prevent bed-sores and hypostatic congestion, the pull of Buck's must, at times, be removed momentarily. With Hodgen's suspension, on the other hand, cleanliness and toilet can be maintained with as little difficulty as in any bed case, and without interrupting the extension force for an instant. In fact, the extension of Hodgen's is at all times completely under the physician's control, unlike that of Buck's. Friends never find it necessary to minister to the patient's sufferings by temporarily resting the weights on a chair; they do not realize, any more than does the patient himself, that there is any pull on the leg. The reason for this is that Hodgen's pull is very elastic, resembles the extension the intelligent physician might make with his own hands to enable the patient to be moved, for instance; while the pull of Buck's-what there is of it is dead. Twenty-five pounds of weights attached to the cord of Buck's by no means signifies that that degree of extension force is acting against the contracted muscles. Just what the actual pull delivered at the thigh may be depends upon various individual factors, but may be practically nil even with such a weight on the cord. As shall be shown, the actual pull in Hodgen's can be accurately measured at all times. DESCRIPTION OF THE APPARATUS The frame is made of iron wire the thickness of a lead pencil or a trifle lighter for lighter patients. A tinsmith or mechanic can construct it in less than an hour. The only measurement necessary FIG. 1. Brady's frame. is the length from the patient's perineum to a point four inches below the sole of the sound foot. That will be the length of the frame. It is made by bending the long iron rod or wire into a U with square angles, the breadth of the base being about four inches, or a trifle wider than the width of the ankle at the malleoli. Small iron rings half an inch in diameter are soldered to the frame, one at each free end, one about four inches from each free end, one about ten inches from each lower angle-six upright rings in all. At each lower angle a stout upright wire post or loop two inches high is soldered firmly, to which the adhe sive extension straps will be tied. A wire wicket, arching four or five inches from its base line, should be hooked into the outer wire ring at the free end, and left free to hook or unhook with the wire ring on the inner free end. The purpose of this wicket is to steady the free ends of the frame under the weight of the limb, preventing undue spread or give when the apparatus is in place (Fig. 1). |