How to treat a broken leg in 1843?

In 1843, treating a broken leg primarily involved immobilization and realignment of the fractured bone, relying heavily on the physician's anatomical knowledge and practical skills in an era before modern medical advancements like X-rays, effective anesthesia, or antibiotics.

Understanding Fracture Care in 1843

Medical understanding of fractures in 1843 was rudimentary compared to today. There was no concept of sterile surgery as we know it, and the germ theory of disease was still decades away from widespread acceptance. This meant that even simple open fractures carried a high risk of life-threatening infection. Pain management was also limited, often relying on opiates or alcohol.

The primary goals of treatment were:

• Reduction: Realigning the broken bone fragments as closely as possible to their anatomical position.
• Immobilization: Keeping the bone fragments stable to allow natural healing.
• Prevention of Complications: Primarily aiming to prevent severe infection, though with limited means.

Common Methods of Immobilization and Realignment

The majority of broken legs were treated non-surgically, focusing on stability and rest.

Traditional Approaches

Physicians and surgeons employed various techniques to stabilize the limb:

• Splinting: The most common method involved applying rigid supports to the limb.
  • Materials: Splints were often made from wood, metal, or stiffened leather, padded with cotton or cloth to prevent skin damage.
  • Application: These were carefully molded and secured around the broken leg to prevent movement at the fracture site.
• Bandaging: After splint application, the limb was securely wrapped with linen or cotton bandages to hold the splints in place and provide additional support. Starch bandages, which stiffened upon drying, were also used to create a more rigid cast-like structure, though less sophisticated than later plaster casts.
• Traction: For more complex fractures or those requiring significant realignment, traction was often applied.
  • Mechanism: This involved using weights, ropes, and pulleys to exert a constant pull on the limb, which helped to reduce muscle spasms, realign the bone fragments, and maintain proper length.
  • Application: Patients would typically remain in bed, often for extended periods, with the leg suspended in traction.

Pioneering Surgical Approaches: Early External Fixation

While most treatments were non-surgical, the year 1843 marked a significant, albeit experimental, step towards more invasive fracture management, particularly for complex cases or those that failed to heal naturally (non-unions). This was the very beginning of the concept of external fixation.

• Malgaigne's Devices: In 1843, French surgeon Joseph-François Malgaigne introduced devices that are considered precursors to modern external fixators. While these were not true external fixation as we understand it today, they represented an early attempt to stabilize fractures using external frames.
• Von der Höhe's Method: Also in 1843, a notable advancement occurred when Von der Höhe successfully treated a non-union of the femur (a fracture that failed to heal) by inserting screws into both bone fragments. These screws were then connected externally outside the wound with a device. This procedure, while highly experimental and risky for its time, demonstrates the nascent ideas around directly stabilizing bone fragments from the outside.

These early surgical interventions were extremely rare and carried immense risks of infection and other complications, given the lack of anesthesia for pain control and sterile techniques. They were far from standard practice but highlight the innovative thinking occurring at the time.

Challenges and Risks

Treating a broken leg in 1843 was fraught with difficulties:

• Infection: Open fractures, or even closed fractures that developed skin breaks, almost invariably led to severe infections, often resulting in gangrene, sepsis, and a high mortality rate. Amputation was frequently the only option to save a patient's life from overwhelming infection.
• Pain Management: Pain was a constant and severe issue for patients, with limited effective remedies.
• Poor Healing: Without X-rays, confirming proper bone alignment was difficult, leading to common complications such as:
  • Malunion: The bone healing in an incorrect position.
  • Non-union: The bone failing to heal altogether, as seen in the case treated by Von der Höhe.
• Prolonged Recovery: Patients faced long periods of immobilization and recovery, often leading to muscle atrophy, joint stiffness, and a diminished quality of life.

Table: Overview of 1843 Fracture Treatment Approaches

In summary, while basic principles of reduction and immobilization were applied, the absence of modern medical tools and understanding made treating a broken leg in 1843 a formidable challenge with significant risks and uncertain outcomes for the patient.