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The oft repeated aphorism that "we enter life through the brim of the pelvis, and leave it through the neck of the femur" is one that even today carries much ominous truth. The treatment of fracture of the neck of the femur in recent years by means of the Whitman spica has favorably altered the prognosis of this injury. However, the application of a full spica, extending from the ribs to the toes in an elderly patient, is an expedient often fraught with serious consequences, On account of the dorsal decubitus which the spica necessitates, plus the undue confinement of the costal cage, with consequent diminution of the respiratory excursion, the patient is exposed to the great danger of hypostatic pneumonia. Many patients who are treated for fracture of the neck of the femur in the classic spica succumb not to the fracture but to hypostasis in the pulmonary circulation.
Galland WI. A CONVENIENT ABDUCTION SPICA FOR PROLONGED IMMOBILIZATION OF THE HIP JOINT. JAMA. 1931;96(2):110–111. doi:10.1001/jama.1931.27220280003008c
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