Orthopedics: Walking on a Broken Leg

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"Get the patient out of bed and walking," has become an increasingly familiar refrain of surgeons after virtually every kind of operation. But there seemed to be one obvious exception: if the patient has a broken leg — or, worse, two broken legs — should he not stay in a cast and flat on his back for weeks? No, concluded Orthopedic Surgeon Ernst Dehne of the Veterans Administration Hospital in Memphis; let him start walking as soon as the cast is dry.

The broad-scale test of this idea was carried out at the Army's Fitzsimons General Hospital in Denver with wounded servicemen returned from Viet Nam. Last week in Chicago, Colonel Paul W. Brown told the American Academy of Orthopaedic Surgeons that 56 servicemen with open tibial fractures had been treated this way.

The Fitzsimons doctors paid little attention to skin and muscle wounds, covering them with only a light dressing and proceeding immediately to the job of setting the leg and putting on the cast. Within 24 hours, they had the patient on crutches and encouraged him to put as much weight on the broken leg as he could tolerate. This proved to be highly variable. "But," said Colonel Brown, "we did not push if there was pain." One thing that spurred the servicemen on was that they had to be either up and in motion, or lying down with the leg elevated to avoid edema and other complications.

The average time in plaster was 19 weeks, but some men got out in seven. All the fractures healed, there were no amputations, muscle atrophy was kept to a minimum, and the only men who needed braces were those with nerve injuries.