The Thomas Splint in World War I

RMC Personnel Training with the Thomas Splint

By James Patton

The Thomas splint is an orthopedic appliance used to stabilize a fractured leg to minimize further damage, pain, and bleeding during transportation to a surgical facility. 

It was developed in 1875 by the Welsh physician Hugh Owen Thomas (1834–1891), who is known as the pioneer in Britain in orthopedic surgery. Although Thomas didn’t actually make one of these devices himself, he described it in his book entitled Diseases of the Hip, Knee and Ankle Joints with Their Deformities, Treated by a New and Efficient Method, published in 1876. Thomas was a homeopathic physician and believed that the body could heal itself if put in a state of rest.

The device described by Thomas consisted of a metal ring which was wrapped in leather and fitted around the top of the leg at the groin, then attached by two cylindrical metal rods to another ring that was fastened around the ankle. A simpler design was also used in which the rods and ankle ring were replaced by a single piece of metal bent in a u-shape that hooked around the boot and fastened to the proximal ring. At least two adjustable straps of leather would be tightened around the long rods to secure the leg to the splint. In battlefield situations these straps were often supplemented by roll puttees. A distal cross piece made of bent metal could be attached to the rods to suspend the leg in the air, and at times there was also a proximal cross piece to achieve full suspension. The overall effect of the Thomas splint is that longitudinal tension is applied to the leg, which tends to align and straighten it.

Hugh Thomas and Robert Jones

 

In 1915, Thomas’s nephew Sir Robert Jones, MD (1857–1933), himself a prominent early orthopedist, was mobilized into the Royal Army Medical Corps (RAMC). Upon observing what was happening at the front, he advocated the introduction of the Thomas splint as an aid in the transport of patients. He maintained that this practice would greatly reduce the aggravation of the injury, infection, and pain that was resulting from the inevitable rough handling of the wounded prior to their arrival at a Casualty Clearing Station. He also noted that leaving the affected limb in the splint could allow a surgeon 360 °-access to the leg.

The RAMC quickly adopted the device, and by 1918 it was noted that the mortality rate from compound fractures of the femur had been reduced from 87 percent to 8 percent, although other improvements in treatment protocols and procedures also contributed to this result.

Later, the Pearson attachment was added to the splint. This attaches to the splint at the knee and enables the balanced suspension of the leg.

Although over the years changes have been made to the design of the device, primarily being the substitution of modern materials, the Thomas splint is still in use today. I’ve been told that the RAMC Field Orthopedic Kit that is issued today contains one Thomas splint.