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Rest and immobilization – these are two principles championed within the practice of orthopedics. Simply put: if it hurts, don't move it.
If you have ever had the unfortunate experience of fracturing a bone in your arm or leg, then you have likely been placed into a splint. The modern “Thomas” splint is one of the most common pieces of medical equipment used in hospitals. It is a simple tool used to effectively immobilize limbs and has successfully reduced the morbidity and mortality that was once involved with limb fractures.
The Thomas splint was first introduced by Hugh Owen Thomas in 1875, in his book titled, Diseases of the hip, knee and ankle joints with their deformities, treated by a new and efficient method. Thomas was a Welsh physician who specialized in the study and treatment of diseases affecting the musculoskeletal system – primarily tuberculosis, polio, and rickets. He believed in the body’s natural ability to heal and advocated rest as a method of treatment.
The first variation of the Thomas splint was used for treatment of tuberculosis affecting the knee. The initial design included a metal ring, wrapped in leather, fitted around the groin and attached by metal rods to a smaller ring around the ankle. Traction would be applied by tightening strips of leather supporting the leg around a crossbar. This was a simple design that Thomas believed could be widely accessible and affordable so that even the poorest patients can benefit from its use.
However, it was not until decades later – following the death of Thomas – that his device would become widely implemented. During the first World War, Robert Jones – consultant orthopedic surgeon to the British Army and nephew to Thomas – advocated the Thomas splint’s superiority in the treatment of femur and tibia fractures. Jones also recognized the splint’s utility in providing adequate exposure of the lower extremity for surgical procedures, and its utility in comfortably transporting patients from the battle front.
Across the western front, the splint was adopted and by 1917, it had become standard issue to army medical teams. Prior to the introduction of the Thomas splint to the Army, estimates of mortality from battlefield fractures of the lower extremity reached 80%. With the splint, mortality rates were reportedly reduced to as low as 15.6%. This remarkable reduction in battlefield mortality cannot be attributed solely to the splint, as medical advances in wound debridement also contributed improved practice. However, its importance cannot be understated.
The functional design of the Thomas splint has remained largely unchanged since its inception. It has become an essential tool among orthopedic and emergency practitioners.
Guest Blogger: Juan Pablo Zhenlio, Brown Medical Student, Class of 2016
