The invention of the Balkan beam frame
By Andrea Emilio Salvi, Igor Dakovic
and Steven Adam Hacking
Reprinted with permission from Injury, Int. 1. Care Injured, 40
(2009) 1237-1238.
Conventional orthopaedic treatment of long bone fractures
often employed an elaborate framework of heavy weights and
cables to apply tension and to suspend limbs in an effort to
maintain fractured bones under constant longitudinal traction of the limb held suspended and in a semiflexed position. As the
limb was kept semiflexed, lesser weights were needed than
when the knee was kept extended, therefore eliminating the
risks of muscular atrophy and articular laxities. The suspended-semiflexed-traction position allowed the surgeon to continu
ously monitor the position and any wounds of the fractured
limb, which is constantly kept in a suitable healing position and
can be massaged and mobilized actively and passively
(Florschutz, 1927). This basic apparatus, commonly referred to
as the "Balkan beam frame" or "Balkan frame", is well-known
worldwide as the overhead frame, found above hospital beds,
from which a splintered limb is slung for the treatment of fracture or joint disease. The Balkan frame is now made from longitudinal, vertical and transverse metal tubes with clamps and
pulleys, but initially consisted of a single or double longitudinal metal beam placed over the bed. This device was
invented by Professor Vatroslav Florschutz
Croatian physician born in Slavonska Pozega, district of
Slavonia, whereas traction, first introduced by Americans
Gurdon Buck and Josiah Crosby, was applied in Germany by
Richard Von Volkmann and in France by Hennequin
(Florschutz, 1911). The Balkan beam frame was first employed
in the surgical department of the Civil Hospital of Osijek
(Croatia) in 1911 (Grujic, 1967; Marinovic, 1984). Professor
Florschutz illustrated his method at the first Congress of
Jugoslav Surgeons held in Belgrade in 1912 (Koporc, 1954),
that was previously printed in 1911 in the Croatian journal Lijecniki Vijesnik (Florschutz, 1911) (Figure 3). The essential
principle is to apply traction along the longitudinal axis of the
fractured limb, with the joint semiflexed and suspended, as
explained in Volume One of the Acta of the first Congress of
the Jugoslav Society of Surgery and the fifth Jugoslav Meeting
for Interventional Medicine (1934). During the Serbian-Bulgarian war, in 1913, Professor Florschutz was sent to
Belgrade (Serbia) as head of both the 29th Field-Hospital and
of the Croatian surgery staff, where he first applied this method
for the treatment of femoral fractures caused by firearms
(Koporc, 1954), hence giving to surgeons the opportunity to
manage wounds without mobilizing fracture ends (Marinovic,
1984). As some European surgeons operated in Serbia during
wars, they learned and took home this fundamental technique,
very often forgetting the name of its inventor (Marinovic,
1984).
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