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JAMA 100 Years Ago
December 16, 2009

A PLEA FOR THE MORE CAREFUL DIAGNOSIS AND TREATMENT OF FRACTURES OF THE EXTREMITIES*

JAMA. 2009;302(23):2604. doi:10.1001/jama.302.23.jjy90043

E. DENEGRE MARTIN, M.D.
NEW ORLEANS

As in all other surgical conditions, great advancement has been made in the treatment of fractures. The suspension method of the lower extremities perfected by Hodgen and the ambulatory treatment suggested by Krause, Dollinger and others, have done much not only for the comfort of patients, but unquestionably have saved many an old sufferer from death by pneumonia. The introduction of anesthesia and the certainty of asepsis have reduced the mortality in compound fractures to practically nil. The advent of the x-ray has made a doubtful diagnosis a certainty and excellent results have been secured by this means in many apparently hopeless cases. It may, therefore, appear strange in the present-day advancement of surgical progress, when technic has reached almost a point of perfection, that one should be pleading for more thoroughness in so important a condition as the treatment of fractures. It is not that this branch of surgery has received less attention, for, thanks to Stimson, Scudder, Allis, Pilcher, Cabot, Hodgen, Whitman, Smith, Kocher, Korsch, Dollinger, Downey, and hundreds of others who have contributed so much to the literature, our technic is nearly perfect, but I have been forcibly impressed by the fact that we are treating to-day more deformed and ununited fractures as secondary conditions than any others in surgery. It strikes me that these bad results are due to one of several conditions; primarily, to our methods of treatment, and, secondarily, to the fact that this particular branch of surgery has not been assigned to its proper domain.

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