US2310566A - Clavicle splint - Google Patents

Description

R. ANDERSON GLAVICLE SPLINT Feb. 9, 1943.

, Filed Feb. 7, 1939 6 Sheets-Sheet l M m 0 M E A w Vfihw W ATTORNEY Feb. 9, 1943. R. ANDERSON CLAVICLE SPLINT Filed Feb. 7, 1939' e sheets-sheet 2 INVENTOR Roar/P ANDERSON ATTORNEY Feb. 9, 1943; R ANDERSON 2,310,566

' I CLAVICLE SPLINT Filed Feb; 7, 1939 6 Sheets-Sheet 3 IA (w n INVENTOR R0051? Auoc'eso/v ATTORNEY Feb. 9, 1943. R. ANDERSON CLAVICLE SPLINT Filed Feb. 'r. 1939 6 Sheets-Sheet 5 INVENTOR Ross/P AA/mwsa/v ATTORNEY Feb. 9, 1943. R. ANDERSON CLAVICLE SPLINT Filed Feb. 7, 1939 6 Sheets- Sheet 6 INVENTOR W Y e m 6 R 0 o N w A A M B ROGER Patented Feb. 9, 1943 UNITED STATES PATENT OFFICE CLAVICLE SPLINT Roger Anderson, Seattle, Wash. Application February 7, 1939, Serial No. 255,075

9 Claims.

This invention relates to improvements in splints designed for the reduction of fractures and for the treatment of injuries occurring in the collar bone, arm and in the region of the shoulder.

More specifically, the present invention relates to splints for the above stated purposes which are of the character of that disclosed in my copending application, filed on September13, 1937, under Serial No. 163,548, upon which the present splint may be considered to be an improvement.

It is the principal object of this invention to provide a splint of a mechanical nature, adapted to be supported in part from the well side of the body of the patient, and without detriment to the injured side; which, without alteration in structure, is-easily reversible and adjustable for application to and treatment of either right or left side; which is quickly adjustable to accommodate persons of different size, and also adjustable as a means of elevating the patients shoulder to any extent necessary or desired for fracture reduction; which is adjustable to provide for bringing the shoulder, as supported, to either an anterior or posterior position as may be required; and which provides that all adjustments for reduction or treatment of injuries may be made about anatomical centers and axes in the normal physiological manner.

It is also an object of this invention to provide a splint, in accordance with the foregoing objects, which does not, in its application, interfere with X-ray examinations of the injured area, nor does it prevent the wearing of the usual clothing by the patient. Furthermore, in the treatment of fractures of the collar bone, it permits use of both arms.

More specifically stated, the present invention resides in the provision of a splint comprising supports and means whereby they may be suspended fixedly at front and rear of the patients chest in part or to the greater extent from the well side of the body, and which suspending means will not become loose or displaced incident to or by reason of respiration or normal body movements. Furthermore, a splint comprising a pair of levers, of the cantilever type, located at front and back sides of the chest, and pivotally attached to said supports and coacting for the support of a yieldable hammock, or saddle, designed for application to the arm pit for the support of the injured shoulder; these levers being independently adjustable in angular position and in length for obtaining the degree of elevation, lateral extension and any front to back movement; that is, any anterior or posterior position of the shoulder, required or desired, and also being movable in their pivotal adjustments on centers coinciding with the sterno-clavicular and shoulder joints, so as to provide that all adjustment may be made in the normal manner.

It is a still further object of this invention to provide a splint of the kind above specified having an arm supporting splint as an extension portion operatively fixed thereto for adjustment on centers coinciding with the shoulder joint, so that elevation and oscillation of the upper arm bone, that is, the humerus, may be eifected about its anatomical center, in a normal and natural manner, and wherein provision is made for rotation, abduction and anterior and posterior flexion of the arm about its anatomical axis.

The various objects of the invention include also the provision of a splint that permits immediate ambulation; fixation of the shoulder girdle and arm at the necessary or desired positions, either with or without traction, which provides for all adjustments on anatomic centers at the shoulder, elbow and over the sterno-clavicular joint.

Still further objects of the invention reside in the details of construction of the Various parts, in their combination and in the use and operation of the splint, and in the method of treating injuries that is made possible only by the use of this splint.

In accomplishing these and other objects of the invention, I have provided the improved details of construction, the preferred forms of which are illustrated in the accompanying drawings, wherein Fig. 1 is a view illustrating use of the present splint, embodying both the shoulder hammock and the arm extension.

Fig. 2 isa similar illustration, showing the shoulder supporting hammock removed and the forearm in a vertical position.

Fig. 3 is an illustration disclosing use of the splint as employing the hammock and the arm extension removed.

Fig. 4 is a perspective view of the splint.

Fig. 5 is a front elevation of the splint showing the forearm extension as turned directly forward at the elbow joint.

Fig. 6 is an enlarged, cross sectional view on the line 6-6 in Fig. 5.

Fig. 7 is an enlarged, cross sectional view on the line 1'! in Fig. 5.

Fig. 8 is a cross sectional view on the line 88 in Fig. 5.

Fig. 9 is a cross sectional detail on the line 9-9 in Fig. 5.

Fig. 10 is a detail of the hammock and arm supporting mountings in disassembled relation, particularly illustrating their construction for quick and easy assembly.

Fig. 11 is a front view of the body part of the splint, illustrating the application thereto of skeletal attachment means for clavicle fracture reduction.

Fig. 12 is a cross sectional view as seen on the line l2-l 2 in Fig. 11, particularly illustrating another method and means for effecting skeletal attachment.

Fig. 13 is a view of a splint of an alternative construction.

Fig. 14 is an enlarged sectional detail of the splint taken on the line l4-|4 in Fig. 13.

Fig. 15 is an enlarged sectional detail taken on the line [-15 in Fig. 13.

Fig. 16 is a plan view of the cantilever levers and the arm suspending hammock particularly illustrating one of the various adjustments for flexing the supported shoulder.

Fig. 17 is a view illustrating use of a shoulder binding strap as an attachment to the present splint.

Fig. 18 is a front view of a splint of still another form of construction.

Fig. 19 is a top view of the shoulder support.

Fig. 20 is a front View of still another form of construction.

Fig. 21 is a side view of the frame structure of the latter.

Before going into a detailed description of the present device, it is thought well to state some of the reasons why the adjustments on anatomical centers and axes are considered so important in the treatment of injuries occurring in the region of the shoulder, such for example, as a fracture of the clavicle, a dislocation of the shoulder, a dislocation of the acromio-clavicular joint with a break of the connoid or trapezoid ligaments.

The vulnerability of the clavicle is not due so much to its anatomical structure as to its particular location, serving, as it does, as a boom which provides the only bony support between the axial skeleton and the upper extremity. Most fractures of the clavicle result from force transmitted through the abducted arm to the shoulder girdle or directly against the shoulder itself..

Fractures of the clavicle also occur, most generally, in the middle third of the bone where the two normal curves meet, and the fracture line is usually transverse or oblique.

In addition to the generally recognized elements involved in the reduction of fractures of the clavicle, there are interesting and vital facts which are not ordinarily stressed but which are of consequence when treatment is considered. One of these facts concerns the normal range of motion of the clavicle. When the outer end of the clavicle is carried through normal extremes of movement, the movement taking place through the sterno-clavicular joint, it traverses an arc of approximately 90 beginning below horizontal and extending to 80 above horizontal. This is one of the facts on which the present invention has been based and the sterno-clavicular joint, as an anatomical center, is one of the major determining factors.

Of the various factors necessary for the satisfactory reduction of a fracture occuring in the clavicle, elevation is of preeminent importance. Frequently, it is required that the shoulder and the attached outer fragment must be elevated up to or above the normal level to accomplish a correct anatomical reduction, and this reduction by elevation must be maintained through a long period while the fracture heals. The generally followed procedure of displacing the shoulder far posteriorly, is not in itself sufficient for obtaining or maintaining reduction and probably has only been used because adequate means for obtaining and maintaining elevation was not heretofore available.

In view of the fact that of the many methods which have been previously employed, none, to my knowledge, has fulfilled the optimum requirements of anatomical reduction, with efiicient immobilization that can be maintained throughout the whole healing period, and which will permit immediate ambulation and free use of the arm on the injured side. The various time honored ambulatory methods such as the Sayre, De Sualt or Velpean dressing, the figure-of-8 plaster or bandage, the clavicular cross, the shoulder spica and numerous others, all fall short in one respect or another. The Kelton or Bohler type crutch splint more nearly approach the desired form of treatment, but the objection thereto resides in the fact that these splints attempt to prop the shoulder up from a base that is mechanically insecure and which moves and shifts with respiration, or with normal movements of the trunk and pelvis; thus, because of inherent instability in the chain-like character of the spinal column, not maintaining a constant and dependable elevation. Furthermore, such an insecure support permits or brings about a great deal of pain in many cases, frequently causes pressure sores, and may result in nerve paralysis.

In view of the foregoing, the present splint has been designed on a new principle; that is, the principle involving the utilization of the physiological centers or axes of the injured bone and bone joints as centers of points of adjustment in the splint, whereby the bones, ligaments and muscles of the injured area are caused to assume and conform to correct anatomical, functional lines. The splint provides a hammock suspension employing cantilever levers for the support of the shoulder, which may be elevated and flexed anteriorly or posteriorly through an adjustment point that overlies the sternoclavicular joint. Thus, I have provided a splint whereby it is made possible to accomplish perfect reduction and maintain such reduction of these fractures, and at the same time permit the patient to be up and about, retaining use of the whole arm. Another feature of this splint is that the reduction and convalescence is painless, the splint is comfortable and many patients can do their normal work after only a few days.

It should be kept in mind that for best results in the treatment of shoulder injuries, particularly fractures, it is essential that the splint be capable of efiecting movement of the shoulder in three directions; viz., up, out and back.

Referring more in detail to the drawings- The splint as herein illustrated comprises various parts, one of which is the body portion, designed for functional suspension or fixation of the hammock attachment for the shoulder and the arm extension; this body part being so constructed as to permit interchangeability for either side of the body. To the hammock supporting levers, hereinbefore referred to as being of the cantilever type, is adjustably fixed an extension operable as a support for the arm and the anchor for a traction means for treating fractures of the humerus and shoulder.

Referring now more particularly to Figs. 1, 2, 3 and 4, it will be observed that the body or supporting portion of the splint comprises a side plate I of rectangular form and of substantial area and transversely flexibly constructed to conform to the curvature of the patients side when disposed thereagainst in use. To the ver tlcal, front and back edges of the plate I are secured flat metal bars 2, the lower ends of which extend below the lower edge of the side plate and are bent laterally toward front and rear with reference to the patient as at 2a. Likewise, the upper end portions of these bars extend upwardly beyond the top edge of the plate and are then curved to positions extended horizontally across the back and front of the patients chest as at 2b, curving downwardly as at 20. To these horizontal parts 2b of the bars 2, plates 3, somewhat elongated and of rectangular form, are fixed in a manner to flatly overlie the back and the chest, each at an elevation corresponding to the region of the upper part of the sternum.

To add to the comfort of the patient in the use of this splint, the inner surfaces of the plate I, plates 3 and exposed inside surfaces of bars 2 may be padded such as by facings of pieces of soft, sheet rubber, or the like, as designated by reference character 4.

In the use of this splint, it is applied to the selected side of the patient in such manner that the plate I is fitted to the patients side below the injured shoulder and above the hip, with the plates 3 resting, respectively, against the upper chest and back. The plates are functionally suspended in this position by use of various straps. One strap, designated by reference character 5, has one end attached by a pivot stud 6 to the bar section 2b and applicable at its other end to a buckle 1 that is attached to the rear bar at a corresponding location; this strap, in use, being extended across the well shoulder of the patient and is adjusted in length through the mediacy of the buckle 1 for a proper and secure support of the splint at a desired elevation, as presently understood.

Another strap l0, attached at one end by a pivot stud H) to the end portion 20 of the bar 2, is adapted for application at its other end to a buckle fixed pivotally by a stud l2 to the corresponding end portion 20 of the rear end bar. This latter strap is extended in use about the patients well side, below the arm in such manner as to coact with the plate i and plates 3 for the retention of the splint in proper position.

In addition to the straps 5 and I0, there are straps l5 and E6, withends pivotally fixed, as at I 5', to the curved end portions 20 of bars 2, between the points of attachment of the ends of straps 5 and I9, and adapted, in use of the device, to be extended in crossed relation about the well side of the body, below the arm at that side and to be applied at their ends to buckles I 1 and it that are pivotally attached to the lower, laterally turned ends 2a of the bars 2, thus coacting with the other straps and parts mentioned, to securely and snugly hold the body portion of the splint in place. These straps, 5, l0, l5 and 16, are illustrated'in dotted outline in Fig. 5 for better illustration of the splint construction, but are shown in full line in Fig. 4.

It is here desired to point out a very important feature of the splint that is obtained by reason of this particular location and arrangement of parts. It will be observed by reference to Figs. 1, 2 and 3 that the splint is functionally supported by the shoulder strap 5, supplemented by the strap It and the pressure plate I. While the crossed straps l5 and it do not support the splint, they do act to prevent the side plate shifting. It is to be noted in particular that the plate 3 is above the region of the breasts, and

will not in that location cause any discomfort to the patient. Furthermore, the upper, curved ends2c of the bars 2 are shaped to clear those body parts to which discomfort might be caused and even the crossed straps leave the breast area unrestricted.

It is further to be noted that the location of those parts extended about the chest, particu larly the strap H] in its association with the bar portion 20 and plates 3, is located about the upper portion of the chest. The chest at that location expands and contracts very little, if any with normal breathing, and thus the band I!) may be drawn snug and will not painfully restrict respiration, nor will it shift, or become loose as is most generally the case in use of those types of dressings or supports employing bands that extend circularl and constrictingly about the abdominal region or about the medial part of the chest. Thus, in this instance, there are not only the advantages that are incident to a permanent, secure support by reason of the relatively high location of the supporting bands, but also, the advantages of comfort to the patient and freedom of movement of the arms and shoulders at both the well and injured sides of the body.

Fixed to the top edge portion of each of the pressure plates 3 is a lug 20, having a flat outer surface against which a flat lever or bar 2| is disposed. A clamp plate 22 is disposed across the bar, and this plate is secured to the top part of the lug by a clamp screw 23 which is adapted to be tightened to hold the lever in any of its different positions of adjustment, and which may be loosened to provide for such adjustment. To facilitate the secure holding of the levers 2 |--2 l in place at front and back of the body, the under sides of the clamp plates 22 are recessed or channeled to form guideways, as at 24, for the slidable adjustment of the levers, and the engaging surfaces of the ears andlugs are knurled, as at 25, to provide that when the clamp plates are tightened, there can be no relative rotation on the lugs, and therefore the levers 2I-2I' which are held thereby in the channels 24, will be held against movement about the pivot centers of the screws 23, and also against any lateral move-'- ment in the channel 24.

These levers 2 l2 l associated with the plates 3, are of cantilever form as was previously stated, and they serve as the means of support for the shoulder hammock. The provision that has been made for the adjustment both in length and in angular position of these levers, relative to the horizontal, makes possible the application of the splint to persons of different size and the elevation of the shoulder to the necessary height for proper reduction or treatment.

The two levers 2| and 2| extend substantially parallel with each other at front and back of the body of the patient, and at their outer ends, that being the ends disposed adjacent the injured side, support therebetwen a hammock 26 applicable to the arm-pit of the injured shoulder and it is through the mediacy of this hammock that the elevating of the shoulder in the reduction of the fracture or the injury is accomplished. The means for mounting this shoulder supporting hammockwill now be described. 7

First, it is to be noted that, at the outer end of each lever, both at front and back, there is a lug or enlargement 21 provided with an end notch28 in which is contained one end of a link 29 held hingedly in place by a vertically directed pivot pin 39 on which the link s pe m t ed o swing in a horizontal arc. The two links?!) serve as extensions for the outer ends of the levers 2i and 2l- At t e swin in ends, e nks ave vertical posts i idly m u t e eb but axially rotatably therein, and at their upper ends, these posts have mountings for the support of the shoulder hammock between them. Thus, it will be understood that, if one of the levers 2| should be adjusted to a definite effective length inwardly from the support 22, and fixed in position, and the other extended or retracted to a difierent effective length, the supporting connection for the hammock provided by the link 29-23 will effect the throwing of the hammock to a posterior or anterior location, or to a neutral position, depending on the extent of adjustment. This anterior or posterior shifting of the hammock 26 will be understood best by reference to Fig, 16 of the drawings, which shows the parts both in full and in dotted lines.

Referring now to the details of construction of the hammock, this is formed from a molded strip of rubber of substantial width and so shaped that when mounted, it will conform to the average axilla or arm-pit. This strip of rubber is suspended from its opposite ends in a frame 35 which is formed by a bar, or rod of metal, bent into U-shape, and of a size to contain the hammock in suspension within the U-portion with ample clearance. The bar is formed, continuing from the ends of the legs of th U-portion, with semi-circularly curved portions 31, about which portions the ends of the rubber hammock are moulded, thereby to hold the strip in suspension The curved portions 31 have their ends bent inwardly as at 31a on radial lines with reference to the centers about which the parts 31 are curved, and each has a disk-like mounting head 38 f xedly mounted thereon. The heads 38 ar coaxially alined and have radial slots 40 directed thereinto from their top edges and terminating at the centers of the heads, as will be observed by reference to Fig. 10.

Referring now to Figs. 4 and 5, it will be noted that the hammock supporting frame 36 is disposed between the posts 32 mounted by the swinging ends of the two extension links 29 and 29', carried on the levers 2I2l, and that the disk-like heads 38 are located within the upper end portions of these posts and are fixedly clamped in place thereagainst by screw headed bolts 42 that extend through the heads at the upper ends of the posts 32 and through the slots 39 of heads 38 and have clamping nuts 42' at their inner ends. The adjustment of the hammock is about the axial line of the bolts 42 and adjustment may be fixed or retained by merely tightening the bolts to fixedly clamp the head 38 against relative rotative movement on their supports. However, slight loosening of the bolts 42 will free the hammock for swinging adjustment in accordance with the elevation or position to which the shoulder is moved, and by further loosening, will permit it to be freed for removal by slipping the heads 38 from the bolts as is contemplated in the provision of the radial slots 40.

Before going into a detail description of the arm splint, or its use, the mode of use of the splint for shoulder injuries will be described, attention being directed in this description to. Fig. 3, of the drawings.

Assuming that the application of the splint is made for treating a fracture of the left clavicle: The supporting body portion of the splintis first shortening of the fractured clavicle.

fitted to the body of the patient by removal of the hamock 25 and disposing the plates 3 and 3' flatly against the front and back of the body as illustrated, The plate I is disposed at the left side of the body directly below the shoulder.

The shoulder strap 5 is then placed in posi-- tion and adjusted to proper length to support the splint, then the strap [0 is applied under the arm at the well side and drawn snug; this being followed by the extending of the straps l5 and IS in crossedrelation about the well side and securing them at their ends in the buckles I1 and I8 at the lower ends of the parts 2a and 2a of the bars 2 and 2'.

As was previously stated, the present splint is based upon physiological principles; every adjustment or movement being made upon the anatomic centers and in the normal manner. Therefore, it is of importance to note that the common axial line of the locking bolts 23, about which the adjustments of the cantilever bars 2l-2I are made, extends approximately horizontally through the sterno-clavicular joint. This point or axis is designated at C in Figs. 1, 2,

s and 13.

Furthermore, it is to be observed by reference to Figs. 1, 2 and 3 that the axis of adjustment of the hammock 26 about the common axis of bolts 42 is in a line approximately through the center of articulation of the head of the humerus as seated in the glenoid or socket of the scapula. Thus, it will be understood that after an adjustment in lengths of the levers 2l-2l' has been made, whereby to aline the axis of the hammock support with the center of articulation of the humerus, then any degree of elevation made by elevating the levers 2l2l about the sternoclavicular joint line as a center will not cause any elongation or retraction of the clavicle that might displace the fractured parts from apposi tion or displace the reduction of the fracture. With the splint applied as shown in Fig. 3, it will be noted upon analyzing the mechanical aspects of this device, that the hammock, as supported by the levers 2|-2l', will support the shoulder at the proper position to maintain the ends of the. fractured clavicle in apposition, with the force being transmitted to the body through the hammock supports 29 and 32 by the levers 2i and the body straps. The pressure tends to hold; the base against the body rather than to depress it, making for stability and comfort. The weight of the arm as supported, falls out naturally over the hammock, thereby tending to further correct over-riding deformity and What posterior displacement might be necessary can be obtained by extension of the front lever 2|, and a retraction of the rear lever 2| or by the elongation of the front lever while the rear lever remains fixed.

The treatment of the fractured clavicle is the same whether it be a complete break or a green stick type of fracture. Comminuted fractures, fractures at the outer end of the clavicle which frequently result, from direct blows upon the shoulder, and the rare fracture at the sternal end of the clavicle, may require special consideration, but generally speaking, the treatment is as outlined and the range of adjustment of the splint allows for a satisfactory correction. Compound fractures are treated by usual methods, employing this splint for immobilization. In. non-unions, which warrant operative treatment. thesplint. is used post-operatively because internal fixations frequently cannot be depended upon to hold the fracture site securely. In this treatment the hammock conforms comfortably to the action of the arm, without. detrimental pressure on nerves and not impairing circulation.

With reference now to fractures of the humerus, and injuries to the shoulder joint which require use of the extension or arm portion of the present splint:

As with most fractures elsewhere, many different treatments have been advocated, but the unanimity of opinion among surgeons at present is that the arm should be fixed in a position of abduction; that is, in the so-called airplane position. This mode of treatment has heretofore called for the arm being held out substantially at right angles to the body, the shoulder brought moderately forward, with about 90 external rotation at the shoulder and 90 fiexion at the elbow. This abduction treatment was thought to allow the best opportunity for correcting displacement,-and afford amore physiological position of rest for the shoulder because, in abduction, the deltoid and supra-spinatus muscles are not stretched, the abductors are not contracted and adhesions do not form between the lower folds of the capsule. While this routine useof full 90 may, in some instances, be desirable, many fractures are best treated with the arm originally nearer the side, and then abduction gradually increased as the bones unite.

These following mentioned methods of treatment are now in general use: First, the plaster of Paris shoulder spica, which immobilizes in but one position of choice. This spica has many disadvantages; for example, it is of excessive weight, it unnecessarily immobilizes a wide area of the body; positions cannot be changed when desired, and the inconvenience of applying traction is an evident drawback.

Second, there is the method employing abduction with the patient in bed, using skeletal or adhesive traction. Manifestly, a method that confines a patient to his bed for weeks is not economically or scientficially correct.

The third method is that of use of abduction splints. However, most splints are so unanatomio and uncomfortable or inefficient that they cannot be used with any degree of satisfaction.

For the treatment of fractures of the surgical neck of the humerus, and also high shaft fractures, I apply the arm support or abduction splint to the base or supporting structure previously described. This abduction splint is attached through the mediacy of the same supporting levers 2l2! and the extension links as used for reduction of .the fractures of the clavicle, thereby taking advantage of the possibility of adjustments permitted in the mounting of the levers, as seen in Fig. 2.

The arm support or abduction splint includes an arm hammock. This comprises a canvas base or strip 50 suspended between supporting bars 5|-5|' in a manner to receive and support the upper arm therein. The bars 5I5l', about which the ends of the canvas strip are looped for secure attachment, are disposed lengthwise of the upper arm, at front and back sides thereof, and have their inner ends adjustably fixed, respectively, to the head portions of the posts 32, by means of the clamping screw bolts 42.

As a feature of the manner of mounting the bars 5l5l, it will be pointed out that each is equipped at its inner end with a flattened, disklike head 53 that is disposed between the fiat head portions of the posts 32 and the mounting heads 38 of the shoulder hammock frame. The outer faces of the heads 53 are serrated or knurled so that, on tightening the clamp bolts, the bars 5| will be fixedly secured at any position to which they have been adjusted.

It will be noted, by reference to Figs. '7 and 10, showing both the shoulder supporting hammock and the arm splint assembled together, that the nut 42' is provided with two cylindrical portions 42a and 42b, the portion 42a being somewhat smaller than the portion 42b. Furthermore, it will be noted that there is provided a slot 54 in the head 53, disposed at a slight angle below the horizontal, and that there are recesses 38a and 53a in the heads 38 and 53 respectively. This provides that the shoulder supporting hammock and the arm splint may be assembled easily and that it will not be necessary to remove the nut 42. {The last thread on the bolt 42 may be jammed so that the nut 52' cannot be taken oif and lost or misplaced. In assembling these parts, the slot 54 in. the head 53 is slipped over the bolt 42, and the bolt tightened slightly so that the portion 42a enters the recess 53a, thereby retaining it assembled, but free to be rotated. Then the slot 40 in the head 38 is slipped over the portion 42a and the nut 42' tightened until the portion 42b enters the recess 3812. Then the parts may be adjusted to the desired positions.

In the usual construction of this support, the bars 5| of the arm hammock extend to about a medial position between shoulder and elbow and they are rigidly joined at their outer ends by a semi-circular, downwardly curved frame composed of a pair of parallel bars 56 to which is adjustably fixed an extension bar 58. The bar 58 is formed with a longitudinal slot 59 and its inner end portion overlies the bars 56, and at this end it is securely fixed by means of a bolt 60 that extends through the bar slot 59 and through a clamp plate 6! that underlies the bars 56. A wing nut 62 may be tightened against the plate to clamp the extension 58 at any position of extension provided for by the slot 59 therein. Furthermore, the bar 58 may be moved to any desired position of rotation on the bars 56, and

clamped in that position by the nut 62 on the bolt E9. This provides for rotation of the forearm from a position as seen in Fig. 1 to a position as seen in Fig. 2. It is an important factor that this rotation be on the anatomical center of the upper arm and the shoulder joint.

At its outer end, the extension bar 58 mounts a traction plate 65 carried by a rod 66 which has sliding adjustment in a lengthwise direction with reference to the bar 58, in a bearing block 61 that is mounted at the outer end of the bar 58. The rod 66 is in effect a continuation of bar 58 and at its outer end, is bent to form an end mounting 66a, lying transversely of the line of the humerus and beyond the elbow, and on which plate 65 is pivotally carried.

Threaded on the rod 66, for adjustment there along is a nut 68, and interposed between the nut and the bearing 61 is a coiled spring 69 for yieldably sustaining tractive forces applied through use of plate 65 as presently understood.

With the splint functionally applied, the degree of abduction of the arm is controlled by the adjustment of the supports about the shoulder joint. Adjustment of the bar 58 about the arcuate bars 56 takes'care of rotation of nearly 180 at the shoulder.

When traction is to be applied by adhesive or skin traction, the adhesive tape strip is out long enough to reach from the point of the shoulder down the arm, around the traction plate 65 and then back under the arm to the axilla or armpit. The traction plate 65 is removed from its mounting rod and is centered in this adhesive strip. The adhesive is then applied to the arm and properly reinforced with cross strips and bandages, The splint is then fitted to the patient, the traction plate 65 slipped onto its mounting and the necessary degree of traction applied by the adjustment of the nut 68.

Constant traction in a direct line with the humerus is maintained by the spring 59 and the rocker or pivotal action of the plate 55 on the rod 66a equalizes the pull on both sides of the arm.

Should it be desired to use direct skeletal traction in lieu of the adhesive skin traction, a pin or suitable Kirschner wire is placed through the proximal ulna. A few turns of plaster-of-Paris bandage around the tranfixion incorporates it and prevents lateral slipping. Pull is made from the incorporated transfixion to the traction attachment of the splint.

When using traction, the shoulder or clavicular hammock 26 is slipped under the arm and attached to the frame at the shoulder pivots as seen in Fig. 1; thus the hammock 25 furnishes a countertraction force without which reduction is impossible and prevents the splint slippin upward.

Attached to the outer end of the extension bar 58 is a forearm support. This comprises a bar 5 formed at its outer end with an upturned portion a which mounts a pivoted rubber padded cross handle 75 properly curved to fit the hand and which the patient may grasp in the hand. At a medial part of the bar, a padded arm rest plate 18 is fixed for reception of the forearm, and at its inner end, the bar is formed with a longitudinal slot 19 through which a mounting bolt 80 is extended to fix the bar to the outer end of bar 58.

In order to accommodate the forearm movement, the bar 15 is rotatable about the bolt 80 as a center and may be locked at different positions by tightergng of the bolt. However, to insure against slippage when an adjustment has been made, the bar 75 is slidably fitted in a channel 85 in a knurled disk 86 and this disk is fitted to a similar, opposing disk 81 that is fixed to bar 53, The mounting bolt 80 extends centrally through these disks and at its lower end is equipped with the tightening wing nut 80. It will be noted that the bearing block 6! is a part or extension of the disk 81.

This splint may be applied to either the right or left arm merely by loosening bolt 80 anclswinging the forearm support to the proper side. The line of the bolt 80 should coincide with the elbow joint and is brought to this position by loosening the wing nut 62 on the bolt 69 for longitudinal adjustment of bar 58. The forearm support likewise is brought to proper length by loosening the wing nut 80' on the bolt 89 for shifting of bar 75.

Assuming the parts to be so constructed and assembled, the application thereof would be as follows:

First, it is well to disconnect the body and arm portions; this being done by unscrewing the bolts 42 at the shoulder joint. The arm splint, when detached, is laid aside for a proper fitting of the body portion to the patient, as previously described. Then, with the body portion in place, tight but made comfortable by use of padding where needed, the arm attachment is slid under the injured arm and secured in place.

With the parts connected, three different adjustments at the sterno-clavicular joint can be made: (1) the levers 2l-2l can be shifted lengthwise to place the shoulder joint of the splint in registration with the shoulder joint of the patient. (2) The levers can then be elevated by pivoting about the bolts 23 to raise the shoulder to the desired height. (3) The shoulder joint can be moved anteriorly or posteriorly by extending one of these bars while the other is held stationary or retracted.

Rotation of the upper arm and adjustment of the splint to the correct humerus length is obtained by loosening the bolt 60 to allow the bar 58 to be slid along the arcuate bars 55. It will here be stated that the axis of curvature of these bars coincides with the anatomical axis of the humerus.

The nut at the elbow joint can be loosened to allow adjustment of the arm extension. Thus the splint is made to coincide entirely to anatomic lines and will be comfortable. When skin or adhesive traction is to be used, the plate 65 is applied to the adhesive strips, and the adhesive is applied to the arm, preferably before the splint is applied.

If skeletal traction is to be used, the traction pin is applied, then the incorporated transfixion is connected to the traction plate by means of a bandage or rubber tubing. The necessary traction is obtained by adjusting the tension nut, and the amount of extension is judged by the extent of compression of the spring.

Provision is made also, in this splint for use of a shoulder strap designed for application over the shoulder at the injured side, in cases where a break or rupture has occurred in the acromioclavicular ligaments, the conoid ligaments or trapezoid ligaments; the purpose being to provide a means whereby to hold the clavicle in proper place while these parts become healed.

The shoulder strap, as above referred to, is illustrated in its use in Fig. 17, and is shown in dotted lines in Fig. 5, being identified by reference numeral Eat. It is adapted to be attached at its ends to the horizontally directed portions 212 and 2b of the bars 2 and 2 in the same manner as strap 5 is attached, as by application to a pivot stud 6a on the front bar and a buckle attached to the rear bar. This strap, properly applied and adjusted in length, will cooperate with the shoulder hammock in holding the clavicle in place, particularly in case of dislocations and ligament breaks in the region of the acromioclavicular joint.

It is further contemplated that skeletal traction may be applied to a fractured clavicle in certain circumstances, as illustrated in Figs. 11 and 12, which disclose the application of traction pins or wire to the fracture fragments; these pins and wire being of the same character as now generally used in my other skeletal traction devices. In this provision, an arcuately formed member 90, having knurled or serrated disc-like heads a, is fixed between the heads of the posts 32 and held in the desired position by the bolt 42 and nut 42'. A clamp 9| is locked in the desired position upon this member 90 by a bolt 92, and a bar 93 which holds the skeletal pins 94 and 95 is mounted by a universal ball and socket joint 9'6'on this clamp, with means to lock or hold it in any of its universal adjustment positions.

As seen in Fig. 12, a traction wire 91 may be extended through the clavicle and held taut by clamps 98 on the member 90; looking bolts 99 being provided to maintain theclamps 98 in place.

Figs. 13 to 15, inclusive, show an alternate form of splint, comprising front and back side bars or levers I-I00', supported from the suspended plates I02-I02', which have their inside surfaces padded with sheet rubber, as seen at I03 in Fig. 14. These plates are pivotally attached to the bars I00I00' as at I04 by means of a formed bracket I00 that is riveted or otherwise fixed to the plates I02, as at I01. Two straps H0 and HM for supporting the device, are fixed to the rear plate I02 by suitable studs. and these straps overlie the shoulders very close to the neck of the patient for support of the splint, and buckles III and la are provided on the plate I02 so that the splint may be ad justed to the proper position, and to accommodate people of different stature. The bars I00 curve downwardly at the well side of the patient, as at I00a, allowing ample body clearance for adjustment as will be subsequently explained. A strap H5 is fixed to the lower end of the rear bar I00 and is disposed about the waist of the patient, and is adapted to be received in a buckle II! that is fixed to the front bar by a stud IIB.

Sliding clamps I20 are mounted on the outer ends of the front and rear bars I00-I00' and are provided with threaded locking bolts I2I. Pivotally mounted in these clamps, as at I23, as seen in Fig. 15, are links 29, which mount posts 32 of the same construction as in the preferred form of construction. The same shoulder sup porting hammock and arm extension may be used as in the preferred form of construction.

In operation, with the splint applied as described, elevation may be accomplished by drawing the strap II5 tighter so that the bars I 00a are drawn inwardly causing the lever portions I00 to pivot on the stud I04 thereby elevating the shoulder.- Front to back shifting of the shoulder may be accomplished by adjusting the clamps I20-I20' to different positions along the bars I00 and maintained in such position by tightening the bolts I2I.

This form of device is much simpler in construction and application, and can be marketed at a much lower price, which is a decided advantage where capital invested has to be considered.

By the use of this splint, it is obvious that fractures of the clavicle may be reduced and injuries to the shoulder and shoulder area may be treated by the doctor with much greater speed and accuracy, and also with much less pain and sulfering to the patient. Furthermore, in reducing such fractures in accordance with the principles set forth; namely that of adjusting the bone fragments to normal positions, taking into consideration the tendency of the trapezius and pectoralis muscles, along with the weight of the arm, to pull the arm and the outer fragment of the fractured clavicle down, in and forward from the inner fragment thereof, and the tendency of the sternocleidomastoid muscle to pull the inner fragment up and away from the outer fragment, a perfect reduction may be accomplished and maintained.

Referring now to the modification shown in of the shoulder.

This device comprises a side frame I25 equipped with side plate I25 and suitable padding as at I20, for engaging against the patients side. From this frame I25, front and rear bars I 2'II 27' extend to the front and back of the patients body and then are joined across the shoulder close to the neck, forming a support designated at I28. A pad or plate I29 is fixed to this member to ease the pressure on the neck.

As noted in Figs. 18 and 19, a lever I30 is pivotally attached at its inner end, as at I3I, to the bar I28, directly over the shoulder, to extend somewhat beyond the shoulder. Supported by and adjustable along the lever I30 is a yoke I32 whereby a hammock I33, like or similar to that already described, is supended. The yoke is hold in place on the lever by a bolt I34 extended through a longitudinal slot I34 in the lever, and may be held at an adjusted position by tightening a nut I35 on the bolt to clamp the yoke and lever together.

Threaded through the lever I30 to engage at its lower end against a plate or pad I36, is a bolt I38, which, by adjustment into or from the lever I30, will cause the outer end of the lever to be adjusted upwardly or downwardly accordingly, thus to raise or lower the shoulder when suspended by the hammock.

Also, by reference to Fig. 19, it is noted that the plate I30 is serrated or notched, as at I36a, to be engaged by the pointed lower end of the bolt' I38, so that the angular position of the lever I30, with reference to movement in a backward or forward direction may be maintained.

The yoke I32 i pivotally movable and thus will accommodate itself to the position to which the shoulder is adjusted, and then the nut I35 tightened on the bolt I34. Y

The alternative device of Figs. 20 and 21 has a frame structure like that of Fig. 18. However, the shoulder lever I30 is eliminated, and in its stead, a vertical support for the shoulder hammock is provided. This support comprises a threaded shaft I40 mounted slidably in a supporting yoke I4I that is pivotally fixed by a bolt I43 to the frame I25. Vertical adjustment of the shaft is effected by the adjustment of nuts I44 I44' thereon to engage the yoke MI, and this permits the obtaining of a desired elevation The front or back movement of the shoulder support is obtained by the front to rear swinging of the hammock, and this is permitted by reason of the pivotal fixation of the yoke MI by the bolt MI. The base of the yoke I 2| is arcuately curved, as at Nile, and is longitudinally slotted as at I4lb to permit in- .Ward or outward tilting of the vertical shaft I40 and the locking at any position by tightening the nut I45 on bolt I43.

The surface of frame I25, directly engaged by the base of the yoke MI, is knurled, or serrated, as seen at I50 in Fig. 21; thus when the parts are tightened together, there will be no slippage.

This splint, as shown in Fig. 20, provides for the vertical adjustment of the patients shoulder byreason' of the vertical adjustment of rod I40. It provides for lateral in'or out adjustment by reason of the rocking action of the yoke Ml on the frame (25, and front to back action of the shoulder is provided in the pivotal action of the yoke Mi on the 'bolt 53. Thus all the essential movements are possible and may be easily and readily accomplished.

It is to be understood that in the device of Fig. 20, the vertical rod Iii] is pivotally fixed to the base of the yoke I32 previously described and that the yoke mounts therein the hammock I33, as in the device of Fig. 18.

In the application of the devices of Figs. 18 and 20, the frame is applied against the patients side and over the shoulder, and is held in place by a strap 13? that may be extended about the opposite side of the patients body either below the arm or about the neck.

Having thus described my invention, what I claim as new therein and desire to secure by Letters Patent is:

1. A splint of the character described, comprising a body harness adapted to be fitted and functionally secured to the body of a patient under treatment, levers mounted by said body harness to extend laterally at front and back side of the body to the region of a shoulder, and a hammock suspended by and between the outer ends of said levers for application to the arm pit, as a support for the said shoulder; said hammock mounting levers being pivotally adjustable on the said harness about an axial line that passes from front to back of the harness and the hammock being pivotally suspended between the outer ends of the levers on a hinge line from front to back.

2. A splint of the character described, comprising a body harness adapted to be fitted to and functionally fastened to the body of the patient being treated, a pair of levers mounted by said harness at front and back side of the body and extending laterally to the region of the shoulder at the side of the body containing the injury, an extension link hingedly mounted on each lever, and a hammock pivotally suspended by and between the outer ends of said extension links for application to the arm pit as a support for the said shoulder.

3. A splint as recited in claim 2 wherein the said levers are individually adjustable in length for obtaining a desired displacement of the shoulder outwardly from the body and a desired anterior or posterior displacement, and clamping means are provided for retaining the levers in fixed adjustment.

4. A splint of the character described, comprising a frame adapted to be fitted to and functionally secured to the patients body, and having a side plate of substantial area for bearing against the patients side corresponding to that containing the injury, back and front plates rigidly supported from the said side plate for bearing against front and back sides of the body at the height of the upper part of the sternum, an adjustable supporting strap for the frame extended over the shoulder at the well side, another strap extended about the chest directly below the well shoulder and adjustably secured to the said frame, levers mounted by the said front and back plates and extended laterally to the region of the shoulder at the injured side and a shoulder supporting hammock mounted by said levers.

5. A splint of the character described comprising a body harness and a support for the injured shoulder adjustably fixed thereto; said body harness comprising a side plate of substantial area fitted to and adapted for bearing against theopatients side below the shoulder to be supported, front and rear plates fixed rigidly to the said side plate and adapted to engage flatly against the patients body at front and rear at an elevation corresponding to the upper part of the sternum and supporting straps fixed to said front and rear plates and adapted to be extended respectively over and directly below the patients shoulder at the well side to support the said plates in positions; said shoulder support being mounted by means extended only from the said front and rear plates.

6. A splint of the character described comprising a body harness, a pair of levers mounted thereby to extend from the central portion of the body at front and back, laterally to the region of the shoulder at the injured side of the body; said levers being pivotally adjustable on the harness, when functionally applied, about centers alined with the sterno-clavicular joint at the injured side, and an arm splint mounted by the said levers and adjustable in their mounting about a center alined with the center of the shoulder joint.

'7. A splint of the character described comprising a body harness, a pair of levers mounted thereby to extend from the medial portion of the body at front and back, laterally to the region of the shoulder at the injured side of the body; said levers being pivotally adjustable on the harness, when functionally applied, about centers alined with the sterno-clavicular joint at the injured side, an arm splint mounted by the said levers and adjustable thereon about a center alined with the center of articulation of the humerus at the injured side, and a shoulder hammock pivotally supported by said levers for application to the arm pit at the injured side of the body.

8. A splint of the character described, comprising a body harness adapted to be fitted to the body of a patient .to be treated, cantilevers mounted thereby to extend from substantially the central positions at front and back of the patient to terminate at locations in the region of the shoulder at the injured side; said cantilevers being individually adjustable in length and pivotally mounted for up and down adjustment at their outer ends, means for fixing the levers in different positions of adjustment, a hammock pivotally suspended between the outer ends of said levers to support the shoulder at the injured side of the body, an arm splint fixedly attached to said levers, and a traction plate mounted by the arm splint, beyond the elbow, as an anchor for traction straps applicable to the patients arm in opposition to countertraction afforded by the shoulder hammock.

9. In a splint of the character described, a body frame, a shoulder hammock and means for functionally supporting the hammock from the body frame; said hammock comprising a U- shaped frame applicable to the arm pit and formed with opposite end portions arcuately curved upwardly and designed for disposition at front and back of the shoulder and having pivotal action in .the hammock support, and a strip of flexible conformative material suspended by and between the end portions of said frame and shaped to substantially conform to the average arm pit.

ROGER ANDERSON.

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