An elderly woman presented with a pathological fracture of the right humerus. Progressive dissolution of the shaft of this bone took place over six months. No cause could be established and the patient refused biopsy. With only simple splintage for treatment the humeral shaft gradually reformed and re-ossified over a period of two years. The patient has been under review for four and a half years and no further pathology has come to light. The cause of the osteolysis remains obscure.

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Under the present system we have had the opportunity of seeing patients on whom primary reduction and fixation of a fractured shaft of humerus had been performed elsewhere. Many of these cases have had time and care spent on elaborate methods 'of fixation, with disappointing results. Commonly, some form of abduction splint or plaster has been used. We have also heard from individual surgeons, who express dissatisfaction with these and other popular methods of treatment.The three-splint method, with collar-and-cuff sling, which will be described later, has given consistently good results for many years, and would appear to have considerable advantages over methods which employ the abducted position. Before describing the method and the principles which underlie its use it is interesting to review the more usual ways of treating the fractured shaft of the humerus. Usual Methods of FixationMethods of fixation may be divided into two types: (1) abducted or semi-abducted positions, where gravity acts adversely on the position of the fragments; (2) arm-by-the-side positions, where the force of gravity assists in reduction and in maintaining position. Abducted or Semi-abducted PositionsThe-shoulder spica, abduction frame, and Thomas arm-splintt all fall into the first group. The shoulder spica is not easy to apply while maintaining accurate reduction of the fracture. It does not always hold reduction when applied for an oblique fracture, and it is unnecessarily inconvenient for the patient and surgeon when simpler methods are as efficacious.The abduction frame requires constant attention, and should it slip or sag considerable displacement of the fracture will occur. In the case of oblique fractures skin traction is not to be relied upon, and skeletal traction, by means of a 'pin or wire through the olecranon, is often used with the abduction frame. Such traction has been shown to cause non-union and, if a pin is employed, elbow stiffness or worse. It is hard, under any circumstances, to justify skeletal traction in the treatment of a fresh fracture of the humeral shaft.The Thomas arm-splint requires recumbency, which of itself is a disadvantage. With this splint traction must be used, and may lead to non-union or malalignment if the carrying angle is not watched carefully.All of the above methods may give excellent results under the care of the individual surgeon, but in present circumstances, when evacuation of casualties is often essential, they are cumbersome anid frequently fail to hold the fragments in a reasonably good position. The Thomas arm-splint is especially difficult to manage in transport, as the arm must stick out at right angles to the patient. Arm-by-the-side PositionsArm-by-the-side methods, where advantage is taken of the force of gravity, include the hanging cast, the U-shaped plaster slab and sling or collar and cuff, and the three-splint method with collar-and-cuff sling.Use of the extension hanging cast is discouraged for two reasons-its very weight may succeed in producing non-union, and there i...

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