ORTHOPAEDIC SURGERY. In this branch of surgery, which deals with the rectification of congenital and acquired deformities, particularly those of the limbs, great advances have been achieved during recent years as a consequence of the excep tional opportunities of study and practice afforded during the Great War. Thus the treatment of fractures during the early part of the War was attended not only by unnecessary deformity, but also by a high mortality, and remained unsatisfactory until special hospitals were started, manned by teams of expert surgeons. In compound fractures of the femur an initial mortality of 8o% was ultimately reduced to 25%. This dramatic change was accomplished by immediate reduction and fixation of the fracture, by segregation and by continuity of treatment. Knowl edge thus gained has formed the basis of the efforts to place the organisation and teaching of fractures upon a different basis with a view to minimising the disabilities of industrial accidents. Reform lies in the simplification of apparatus, and in an intensive education in their application, in segregation of fractures in special wards and in appointing surgeons with special qualifica tions to teach the student.
Among certain reconstructive opera tions in the case of which a greatly improved technique has resulted may be mentioned repair of injuries to the peripheral nerves, tendon transplantations, bone grafting and bone infec tions. The enormous number of complete nerve lacerations enabled a finished operative technique to be built up, which was largely wanting previously. Many misconceptions were also corrected, such as the worthlessness of complete transplants of nervous or other tissue to bridge gaps in peripheral nerves, and the doubtful value of lateral nerve anastomosis. In cases of irreparable destruction to nerves, healthy muscles were trans posed to take the place of paralysed ones. These operations proved singularly successful where large tracts of the musculo spiral nerve were irreparably damaged.
Certain flexor muscles of the forearm were attached in such a way that extension of the wrist and fingers became assured. Bone graft surgery likewise received a great impetus and has since been extended. This has led to considerable research on the viability of transplanted tissue, and in the case of the bone it is held that the transplant is a scaffold along which the fresh bonelaying cells creep from the embracing bone and deposit new bone, the scaffolding itself being ultimately removed by absorp tion. The treatment of virulent infections has been similarly
developed. The Carrel-Dakin method has permanently estab lished itself as well as the procedure of laying open infected bone cavities so that the soft tissues fall in easily to obliterate the gap when the infection is at an end.
The most notable recent advance in orthopaedic surgery in Great Britain has been in the organization for the care and cure of cripples. This has consisted in the establishment of well-equipped open-air hospitals in various parts of the country, known as hospital schools, fully staffed by surgeons specially trained to deal with deformities of every kind. These schools provide treatment and education for the cripple, and are associated with what are known as after-care clinics situated in small towns covering an area of from 4o to so m. distant from the hospital in every direction. These after-care clinics are visited by the hospital staff at stated times, and are attended by out-patients who have been inmates of the hospital school, and by cases from the district, who are often seen at a sufficiently early date to prevent deformities from arising. These hospitals and clinics are run in close association and agree ment with the local practitioners, the education authorities and the Ministry of Health. This scheme, in association with preven tive measures, promises practically to eliminate the cripple. Its aims are to secure the potential cripple at the earliest moment, to give him expert institutional treatment in fresh air and sun light and to secure continuity of treatment until recovery is complete. (See CRIPPLES.) Artificial Light.—Of other recent advances in knowledge, the evolution of the artificial light treatment as an auxiliary form of therapeutics for tuberculosis of bones and joints and of rickets may be instanced. The work of Rollier, Leonard Hill and others has given prominence to the therapeutic value of sunlight (see