The Thomas Splint

D. E. Larsen, DVM

The heat was stifling, and the room was packed. The air conditioner just couldn’t keep pace.

“I hope he finishes this up a little early,” I say to the guy sitting next to me.

He loosens his tie. “Yes, we all need to get out into some fresh air.”

The speaker, a short, gray-haired orthopedic surgeon who teaches at Ohio State University Veterinary School, starts to field some questions from the audience. 

“If nobody asks anything, we are out of here,” I say to the guy next to me. He ignores the comment but unbuttons the top button on his shirt.

Then comes the first question, then another. “Didn’t these guys listen to the lecture,” I say, more to myself than to the guy next to me.

“They must be his residents, they can’t be wanting to stay in the sweatbox any longer,” says my new friend in the tie. 

Then comes another question, “What about using a Thomas Splint on lower leg fractures?” some guy in the front row asks.

“I went to school over twenty years, and I never sat in the front row one day of all that time,” I say.

The guy looks at me out of the corner of his eye but doesn’t say anything.

“I haven’t used a Thomas Splint in 25 years,” the Professor says. “If you are going to repair a fracture, you should repair it the right way.”

“He is a long way from the real world,” I say to this guy next to me.

“What do you mean by that comment,” the guy says, almost like I said something that upset him.

“I mean, he would starve to death in Sweet Home,” I said. “Everybody doesn’t have $3000 to go to a university for a fracture repair on their dog. What do you suppose happens to those dogs?”

“We can’t take care of the world,” this guy says, tightening his tie.

“We don’t take care of half the dogs in this country,” I said with a stern voice. “It is great to sit here and learn how to repair a fracture with equipment that only a fraction of the clinics in the state can afford. But when push comes to shove, you better be able to apply a Thomas Splint on the dog of the little girl who will heartbroken if her Dad puts her only friend in the world to sleep because he cannot afford a surgical repair.”

“And what do you do when the repair fails?” the guy says as he slips back into his sports coat.

“You can say at least we gave it a shot,” I said. “Then you better go back to school and learn how to do it correctly. I have used Thomas Splints on everything from a 6-week old kitten to a 700-pound cow. I haven’t had a failure. There have been a few legs that healed a little crooked, but functional.”

“Let’s slip out of here, and I’ll buy you a beer while you tell me a couple of cases,” my new friend says.

“Okay, but you have to agree to one thing first,” I said.

“And what do you want me to agree to?” he said.

“You have to take that damn tie off if you are going to buy me a beer,” I said. “We had to wear a tie every day in vet school, I haven’t worn one since. Probably won’t until my daughters get married.”

We were in the back of the room, so getting out the door without disrupting the class was easy. This guy takes his tie off as we head to a little bar in the hallway. 

“This feels better,” he says as we find a table.

I am not sure if he means having his tie off or if he is talking about the cool air in the bar. I finally notice his name tag. He is a speaker and a professor at the University of California at Davis Veterinary School.

“How long have you been at Davis?” I ask while we are waiting for a beer. “I knew a guy who did an internship there.” 

“I have only been there a few years,” he said. “What did your friend think of the internship.”

“He died,” I said.

“Oh, I’m sorry,” he said. “How did that happen?”

“He crashed a small private plane,” I said. “He would have been better off just going to work.”

“You have my interest in your comments on the Thomas Splint,” he said. “Convince me that you know what you are talking about.”

“I will compare two cases,” I said. “They were separated by a few years but are good illustrations. Both tibial fractures that involved about half the length of the bone, shattered in the middle half of the bone. One from a gunshot and the other, we did not know what happened.”

“Did you repair both with a Thomas Splint?” the Professor asked.

“The first case was a large Malamute who belonged to a nurse,” I said. “He was chasing the neighbor’s cows, and the neighbor shot him. Shattered the middle half of the tibia. When I first saw him, I stabilized the fracture site with a pressure wrap and a Thomas Splint.”

“That was probably better initial care than many dogs get in a small clinic,” the Professor said. “Then what happened.”

“The dog was brought in by a friend,” I said. “When the nurse finally got there, and we reviewed the films, she wanted a surgical repair. I said that this repair was way over my head. At that time in Oregon, we had limited options for a referral. There was a surgeon in Eugene, and we sent the case to him. This surgeon, who I knew, was amazed when this 140-pound dog with a shattered tibia walks into his clinic. He repairs it with a plate and bone grafts. They have all sorts of complications and followups, but the bone did finally heal. I don’t remember, maybe I never really knew how much the bill totaled. I think she paid something like $4000. This was in the 1970s, that was a whole lot of money.”

“I have seen similar repairs,” the Professor said. “I would guess your estimate was close. And the problems with getting one of those fractures to heal are many.”

“So, do you want to hear the other case?” I asked as I noticed that my beer was still mostly full.

“It must have been different,” the Professor said.

“The second case was a similar fracture in a Blue Heeler,” I said. “We didn’t know how the fracture occurred. The dog belonged to a girl who worked for me. This girl was a bright, good looking girl, who was in a poor marriage. She was in love with this dog, he was probably her closest friend in the world. She had no money. She cried when we looked at the x-rays. The x-rays were probably identical to the first case, but no bullet.”

“So you don’t have many options at this point,” the Professor said.

“Very much between a rock and a hard place,” I said. “I tell her, I cannot repair this surgically. She says there is no way she can pay for a referral; her husband would kill her, she says. I guess I believed that was probably more true that I wanted to know.”

“So you put this leg in a Thomas Splint,” the Professor said.

“We discussed options rationally,” I said. “She was done crying. I said the best option of sending her for surgery was not an option, so what else can we do. Number one, we can cut the leg off, she will do okay without the leg. This girl agreed, but wanted to hear the other options. Number two, we can put her to sleep. There were more tears now, she didn’t want to talk about doing that. Then number three, we can put the leg in a splint. She thought there is no way this fracture was going heal in a splint. I teach my help well. So I say that when a splint works, it works well. If it doesn’t work, which that is a possibility with a fracture like this, then we can fall back on the amputation.”

“So you put the leg in a Thomas Splint,” the Professor said again.

“Yes, I put the leg in a Thomas Splint,” I said. “I checked the leg weekly, only because she worked for me and it was easy to do. At 8 weeks, the leg was healed. I left it in the splint of another 2 weeks, just for insurance. The leg was straight and functional. The bone was thickened with a lot of callus formation. The girl was ecstatic. I think I charged her only for the expendables which came to far less than $100. The leg healed better that the leg on the Malamute and in much less time and with much less trouble.”

“So you think we should put all these orthopedic surgeons out of business,” the Professor.

“I never said that at all,” I said. “But I think for him to stand up there a say that he hasn’t used a Thomas Splint in 25 years is condescending. The Thomas splint has fixed more fractures in years past, than he ever will. And in veterinary medicine today, there is still a place for it.”

“You make a good point,” the Professor said. “When we came in here, I thought I was going have a lesson to teach you. I apologize, I think it was the other way around.”

Photo by Product on Unsplash.

Link to Thomas Splint: https://images.app.goo.gl/jVCjHjzwTCw9NZXU8