This thesis reviews fracture treatment from early
history to the beginning of the First World War; and
treatment of fractures of the femoral shaft from then to
the present day. A detailed review of the knowledge of
fracture healing in relation to fractures of the femoral
shaft is undertaken, with a look at the clinical implica¬
tions which provide a strong argument for cast-bracing.
Other factors such as multiple injuries, financial aspects,
the recovery of quadriceps function and the different
materials and methods are reviewed. The background of
the biomechanical aspects are discussed also. Early
cast-bracing of fractures of the femoral shaft is shown
to be clinically, physiologically and biomechanically a
■sound method of treatment.
The clinical study reviews retrospectively the treat¬
ment of these fractures by traction alone and by traction
and cast-bracing of the first year of treatment during the
years 1974 and 1975; and the experience of cast-bracing
in the Orthopaedic Unit during 1976 and 1977. The first
year's experience of a prospective study is also reviewed.
The less than good results are correlated with any problems
or errors in the technique so that they may be avoided in
future. The biomechanical study evaluates the off-loading
characteri sties of the cast-brace during stance in patients
with femoral fractures alone and aged less than 50 years;
in those with multiple injuries, and those aged over
50 years. To do this, strain gauged transducers were
applied to the cast at the fracture level where it was
circumferentiaily split, and to the hinges at the knee.
They measured respectively the load transfer between the
two portions of the thigh cast, and the thigh cast as a
whole, and the below-knee cast; and by subtraction from
the total limb load, the skeletal force at the fracture
level, and the knee.
The clinical results compare favourably with other
forms of treatment and with other reports of treatment by
early cast-bracing. Fractures at all levels were treated
successfully and the management of the multiply injured
patient was enhanced. The results of the biomechanical
study show that the load carried by the two portions of the
thigh cast, and the thigh cast as a whole, was proportion¬
ately high at first and stabilised at from 20 to 501 of
body weight. The effects of age and concommitant injuries
The biomechanical stability achieved by the brace allows early mobilisation and controlled active motion of
the limb with a graded increase in load as union progressed
which must be due to a physiological feed-back mechanism.
The physiological environment stimulates earlier
union and recovery of soft tissue and joint function.
The hospital service benefits financially, and the
patient, physically, socially and financially.