Twilight Zone on the Orthopaedic Surgery Ward

There were few referrals to the clinic, and I would wander around the wards looking sfor something to learn. I drifted into the orthopedic surgery section for lower extremity fractures.

I cannot exaggerate. I entered a Dark Ages Twilight Zone experience. Ward after ward was filled with beds occupied by young men whose fractured femurs, mostly sustained in motorcycle accidents, were suspended motionless in traction. Each ward was a mausoleum of once-viable legs whose soft tissues had been intentionally neglected until they became bloated yellow-green, wax-infested, "limboid" masses sloughing grayish scales into piles on the bed sheets, the grotesque demarcation drawn as if with a ruler about four inches below their groins. Everything - the skin, the subcutaneous tissues, the muscles and tendons, fascia and nerves were entrapped into functionless, mucilaginous bogs, the debris of rigid fixation in thinking.

The status of the fractures was all that mattered! No motion whatsoever was allowed until the exaltation of the x-rays was satiated . Only then would those ravaged limbs be dared to attempt to restore their function. There were few referrals to the rough months of exhaustive rehabilitation.

At the same time, such treatment to the upper extremities was not conscionable. A prime orthopedic principle is to preserve the viability of the hand at all costs, but the short connection to another limb had not yet been made, and the consummate contradiction totally escaped the entire specialty. This was, of course, well into the time of “advanced” medicine. That was the way it was done. No controlled studies.

I was appalled. I went to the chief of the department and asked permission to do a study, even just to move the patellae, if I promised I wouldn't disturb the fractures - anything to begin to restore some movement early on. He looked through me without expression and tonelessly asked me to submit a proposal. I did. Twice. I never received a reply. I wasn’t a surgeon. And then I was gone. Ten years later, Continuous Passive Motion (CPM) was introduced as a major advance in which the limb is set on an apparatus that provides very slow ongoing movement.