PHILADELPHIA, May 15, 1943. Re Mrs. Dora Fruman. Dr. H. SIVITZ, Philadelphia, Pa. DEAR MR. SIVITZ: Thank you for referring Mrs. Fruman to me for X-ray study. The result of the study is as follows: Hips: There is little change from that of the previous examination. The neck is markedly absorbed and there is no evidence of bony union. Movement was demonstrated at the fracture line. The nail also appeared to have moved somewhat as it is not as far into the bone as on our last examination. Very truly yours, X-RAY REPORT LOUIS EDEIKEN. AUGUST 4, 1943. There is demonstrated the presence of a metallic Albee Preston cup located and fixed to the left acetabulum. The altered femoral neck appears to approximate the metallic cup satisfactorally There is evidence of a potential surgical fracture of the proximal femur with a longitudval cleavage located to the trochanteric portion of the femur splitting the bone for 1 centimeter from the level of the greater trochanter to the shaft. The cleavage here varies from 3 centimeters in width above to 2 centimeters in width below. Interposed in the upper limits of the cleavage area is a semilunar osseous opacity which has the appearance of the removed capital segment of the femur. At the dependent termination of the longitudinal cleavage, there is evidence of a modified transverse fracture through the femur the parts here being satisfactorily coapted, though the fracture is not fiving evidence of complete bone union. It may also be stated that the longitudinal cleavage shows but little evidence of osteogenic reaction and repair In soft parts of the thigh, laterally, just below the level of the lesser trochanter there is an osseous spicule approximately 1.5 centimeters in length-probably due to displaced bone following recent surgery. Mrs. DORA FRUMAN, Philadelphia 47, Pa. DR. LLOYD. UPPER DARBY, PA., September 18, 1943. DEAR MRS. FRUMAN: As requested, I am submitting the following report on your case to date. At the time of the original examination, April 22, 1943, there was an old ununited fracture of the cervical portion of the left femur, with almost complete resorption of the neck and apparent avascular necrosis of the head of the femur. The fractured zone appeared to be transfixed with a metallic flanged nail of the Smith Peterson type, and appears to have shifted in position and is not immoziliging the femoral head. At that time, I recommended that a reconstruction of the hip joint be attempted, if conditions at surgery were found to be favorable. You were admitted to the hospital and on June 23, 1943, under ether anesthesia an Albee reconstruction of the left hip joint was performed, employing an AlbeePreston hip cup in the acetabulum. The Smith-Peterson nail, mentioned previously, was found to be lying loose in the trochanteric portion of the femur and was only held in place by the fibrous tissue about the head of the nail. The SmithPeterson nail was removed and a necrotic channel large enough to admit the index finger was found to traverse the trochanter The nail was not in contact with the head of the femur The cervical portion of the femur was completely absorbed and the head of the femur was completely detached from the shaft, moving freely in the acetabulum. Apparently the ligamentum teres was detached. The head of the bone was removed from the acetabulum and the latter structure cleaned, and a medium sized Albee-Preston cup was installed and anchored with a single screw. The Albee reconstruction was effected and the trochanter was held in abduction from the shaft by means of the reshaped femoral head used as a wedge. A bilateral plaster-of-paris hip spica was applied from the toes of the left foot to the costal archs and from the right knee to the right knee to the costal arch. The patient suffered from a rather severe degree of surgical shock and was in a critical condition for about 24 hours, but responded to blood transfusions, infusions of plasma, and other stimulants. The cast was removed on August 4, 1943, and X-ray study revealed that alinement of the surgery remained good, but there was apparently no effort of healing demonstrated. Traction was applied and the limb held immobilized in a Thomas splint and X-ray studies were made on August 11. At that time there was noted a subtrochanteric fracture with a rather marked degree of angulation, and again no evidence of healing or callus formation could be noted. Increased traction was applied and the patient placed on a concentrated vitamin and mineral therapy, and on August 30, 1943. X-ray studies were again made. At this time there was marked inprovement in the status of the bone tissue, there was considerable evidence of callus formation and early primary union, and the angulation noted previously had been markedly reduced. X-ray studies were again made on September 13, at which time continued improvement was noted and the healing of the bone fracture appeared to be progressing satisfactorily by both primary union and callus formation. The traction and splint were removed and the patient allowed the freedom of the bed. If further information is required, I shall be pleased to furnish you with it. Sincerely yours, JAMES M. EATON, D. 0. UPPER DARBY, PA., February 7, 1944. Re Mrs. Dora Fruman. Philadelphia 9, Pa. DEAR MR. KLEIN: Mrs. Fruman was first examined April 22, 1943, at which time she gave a history of having suffered from a fall, striking the left hip resulting in a fracture of the cervical portion of the left femur. She was operated upon at Mount Siani Hospital at which time the fracture was transfixed with a metallic Smith-Petersen flanged nail. It was stated that the accident occurred August 14, 1942, and that surgery was performed a few days later The patient stated that she had suffered a great deal of pain in the left hip, groin, knee, and foot and at the present time is able to bear very little weight on the left lower extremity because of the increased pain that is produced, and must use crutches in order to be ambulatory Serial X-ray studies submitted were reviewed, which revealed a complete frac ture of the cervical portion of the left femur, and later films demonstrated the fracture zone to be transfixed with a metallic flanged nail which appeared to be in excellent position Later studies however, revealed that an avascular necrosis of the neck and head of the femur had taken place, the nail having shifted in posi tion and was not holding or fixing the head in the acetabulum. We recommended that the patient undergo a reconstruction of the left hip joint in an effort to form a new head of the bone which was absorbed in part, to give the patient a painless hip and functioning hip The patient agreed to these recom mendations and on June 23, 1943, an Albee reconstruction of the left hip joint was effected employing an Albee-Prestion hip cup in the acetabulum. The SmithPetersen nail was found to be lying loose in the rochanteric portion of the femur and was only held in place by the fibrous tissue about the head of the nail. The nail was removed and the channel of necrosis about the nail was found large enough to admit the finger. The point of the nail was not in contact with the head of the femur. The patient was placed in a plaster of paris cast in which she remianed until August 4, 1943, at which time the cast was removed and X-ray study made of the hip joint. X-ray studies at that time failed to reveal any effort on the part of the body to produce any osseous union of the proximal femur, the condition appearing as it did immediately postoperatively. The patient was placed on a high vitamin diet which after several weeks appeared to have a beneficial effect on the appearance of the proximal femur and healing has continued sowly since that time Serial X-ray studies made and the bone healed sufficiently to allow the patient to get out of bed on October 14, 1943. and 2 weeks later began to walk with aid and with a convalescent walker She was discharged from the Osteopathic Hospital of Philadelphia on November 12, 1943, ambulatory on crutches, but still exhibiting a marked weakness and inability to use the left lower extremity in a normal manner Since her return home she has been under the care of Dr. David Silverman, 725 South Third Street, Philadelphia, Pa., and more recently under the care of Dr. Charles H. Brimfield, 6910 Market Street, Upper Darby, Pa. She has been receiving treatment several times weekly in an effort to aid in the rehabilitation of the muscles of the left lower extremity which are now interfering with her recovery The post-operative result, architecturally, is fairly good, but our greatest problem is to reeducate the muscles to have them perform normally. Mrs. Fruman has complained of pain, disability, and weakness in the left lower extremity and particularly the left hip joint and states she is unable to bear her weight on the left lower extremity because of this distress. Motion in the reconstructed hip joint is only about 10 to 15 percent of normal and there is no question of the failure of the muscles of the extremity to respond to treatment or to her efforts in exercising to rehabilitate the muscles. The bone structure has continued to heal and at the time of the last examination appeared to be adequate to support the weight of the patient. She states, however, that on her attempts at weight bearing she suffers such pain in the left hip joint that she is unable to walk or stand except for very short intervals. There is still the possibility that there will be some return of function of the left lower extremity, particularly the hip joint, but I would say at the present time that as far as the function of the left lower extremity is concerned she is suffering from a 100-percent disability. the results from reconstructed surgery have been most disappointing. If there is any further information you may require, I will be pleased to furnish you with it. Sincerely yours JAMES M. EATON, D. O., Attending Orthopedic Surgeon, Osteopathic Hospital of Philadelphia. PHILADELPHIA 40, April 9, 1948. Re Mrs. Dora Fruman. Philadelphia, Pa. DEAR MR. SCOTT: On about August 14, 1943, the patient had a fracture of the neck of the femur and a closed reduction was performed plus nailing. Nonunion resulted. She was seen January 6, 1944, at this office and a brace was suggested for a trial period and reconstruction surgery was advised should the brace fail to give the adequate rest to pain and stability. She was seen again in March 1944 and in the interim she had been no the Osteopathic Hospital in Philadelphia and had had a reconstruction operation by Dr. J. M. Eaton. The operation was not successful and pain, shortening, and instability resulted. The brace was then applied and has been worn since in the hope of giving palliative treatment to the problem. It has been worn up to and including the present time. X-rays of April 3, 1948, show a nonunion with a vitalium cup in the acetabulum. The head of the femur is riding lateral to the joint, apparently in front of the trochanter. Nothing short of a reconstruction procedure such as the Whitman or the Colonna or employing the head as a cartilaginous cup, will bring about a useful hip. I would advise one of these. Very truly yours, J. R. MOORE, M. D. PHILADELPHIA 3, June 8, 1948. Re Mrs. Dora Fruman, Philadelphia, Pa. Washington 5, D. C. DEAR MR. LIPSCOMB: This patient sustained a fracture of the left hip joint on August 14, 1942 This was an intracapsular fracture of the neck of the femur. On August 15, 1942, under local anesthesia the fracture was reduced and nailed with a Smith-Peterson nail. Unfortunately the fracture did not heal and the neck of the femur absorbed. This complication usually occurs in about 50 percent of these cases. This is a painful condition and she suffered considerably for many months after the fracture occurred. She returned home from the hospital on August 31, 1942, and was confined to bed for several months, except for walking with crutches around the house for limited periods of time. In April 1943 it was decided that the fracture never healed and an operation was advised. She refused the operation at that time, and shortly thereafter I entered the service. I did not see her again until April 1948. During the time that had elapsed she had undergone the operation. It was performed by Dr. Eaton, at the Philadelphia Osteopathic Hospital. The Vitallum-cup arthoplasty operation was unsuccessful. She now has a 2-inch shortening of her left lower extremity and a dislocated flail hip which is permanent. She is ambulatory around the house by means of a long leg brace and two crutches. She has constant pain and requires the use of strong sedatives and is a permanent cripple. 1st Session JACK PHILLIPS No. 663 MAY 24, 1949.-Committed to the Committee of the Whole House and ordered to be printed Mr. JENNINGS, from the Committee on the Judiciary, submitted the following REPORT [To accompany H. R. 16721 The Committee on the Judiciary, to whom was referred the bill (H. R. 1672) for the relief of Jack Phillips, having considered the same, report favorably thereon without amendment and recommend that the bill do pass. The purpose of the proposed legislation is to pay out of funds of the District of Columbia to Jack Phillips the sum of $337.15, such sum represents reimbursement to the said Jack Phillips for repairing, at his own cost, his automobile struck by a fire truck while parked on Fourteenth Street SE., on January 23, 1948. STATEMENT OF FACTS The facts are these: Jack Phillips had his automobile legally parked in southeast Washington, when a fire truck, responding to an alarm, skidded and damaged the automobile to the extent of $337.15. A claim was filed with the District government who denied it on the ground that the fire truck was responding to an alarm and therefore performing a governmental function. The streets were slightly icy, but the traffic regulations specifically provide that the driver of any vehicle, including fire trucks, must drive them in relation to the condition of the streets. The fact of the accident and the degree of damage would indicate that there was negligence under this traffic regulation. In any event, even though the damage did result from governmental operation. it is not fair that this single individual should bear the entire expense, rather than have it spread over the entire group of taxpayers who receive the benefits of this governmental operation. This expense should be handled the same as the operation of the Fire Department generally. |