Nails, Stirrups, Plaster

There are five different ways to break a leg. They range all the way from a "greenstick" fracture, where the bone is cracked half through and split longitudinally, to a compound fracture, where the shattered bone juts through the skin. No matter what the break, treatment is always the same: first setting and immobilization, then proper exercise.

Last week Southern newspapers hailed the fracture treatment of Dr. Rettig Arnold Griswold of the City Hospital in Louisville, Ky. For the last 15 years Dr.

Griswold has been puttering away at bone carpentry, improving fracture methods that were developed during World War I. He has patched hundreds of broken legs--with hammer and nails.

Dr. Griswold's treatment, called "double pin skeletal fixation," is painless, but it looks bad. First a patient's leg is anesthetized. Then two long steel pins, one-eighth of an inch thick, are hammered through the leg, above and below the fracture. A small steel mallet is used, and the pins are driven directly through flesh & bone, protruding about an inch on either side.

Next, the leg is set in a "Griswold machine"--a 20th-century model of the rack. The pins are connected on both sides to a kind of caliper and the leg is gently stretched until the two broken ends snap into place. While a surgeon "reduces" the fracture, his assistant watches the bone through a fluoroscope to make sure the ends are fitted. The leg stays in the machine a day or two.

As soon as swelling disappears, a soft plaster cast is wound directly over both leg and pins. Several days later, depending on the type of fracture, the patient is fitted with a "walking iron"--a narrow, U-shaped strip of iron about one and a half feet long. The base slips under the instep like a stirrup, the two long arms are bound with more plaster up either side of the leg.

A person with a bad compound fracture can usually walk on the iron, with a crutch, about ten days after his accident.

The iron permits a stiff rocking motion, which does not jar the leg. Cast and iron are removed after eight weeks. The pins are pulled out painlessly with pliers.

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