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Chapter VI



Management of Bone and Joint Injuries
in Prisoners of War

Prisoners of war who fell into Allied hands were always treated humanely and according to the best Allied medical practices. They seldom, however, received first aid and initial wound surgery as promptly as Allied wounded. This was to be expected, not only because preference was naturally given to Allied wounded but also because of the tactical situation. In all wars, prisoners abandoned during a retreat are always the most seriously wounded. The high incidence of infection among prisoners was easily explained by the usually unavoidable delays before initial wound surgery, combined, in many instances, with the extremely serious character of their wounds.

Circular Letter No. 39, Office of the Chief Surgeon, European Theater of Operations, 5 May 1945 (see appendix A), directed that the Manual of Therapy, European Theater of Operations, and Circular Letters Nos. 71, 15 May 1944; 101, 30 July 1944; 131, 8 November 1944; and 23, 17 March 1945 should be made available to captured German medical officers as guides for treatment, with the understanding that when these officers were caring for protected prisoner personnel they would be permitted to practice such methods of their own as were in accord with reasonable medical care.

Circular Letter No. 39 directed that commanding officers of hospitals utilizing the services of protected prisoner medical personnel should instruct German medical officers that skeletal traction must be used in the treatment of fractures of long bones and that wounds must be closed by suture, by skin graft, or both. The reason for the regulation was that, in the hands of United States Army medical officers, these methods had materially reduced the periods of hospitalization and of subsequent disability.

Equipment for the treatment of fractures of the long bones by skeletal traction was, according to these directives, to be furnished to German medical officers who were capable of using it. Simple illustrations demonstrating correct techniques of fracture management in various locations (figs. 13 through 16) were prepared by Maj. Floyd H. Jergesen, MC, and distributed to these officers. They were permitted to employ Steinmann pins or Kirschner wire, but splints for external fixation, such as the Roger Anderson and the Haines apparatus, were not distributed to them.

When skeletal traction was not employed in the management of compound fractures of long bones, German medical officers were expected to employ circular plaster-of-paris splints. If wounds could not be closed by delayed primary suture, the closed plaster technique was to be employed.


FIGURE 13.-Instructional charts prepared for use of German surgeons caring for protected prisoner personnel. Technique of traction in fractures of humerus.

FIGURE 14.-Instructional charts prepared for use of German surgeons caring for protected prisoner personnel. Technique of traction in fractures of lower humerus.


FIGURE 15.-Instructional chart prepared for use of German surgeons caring for protected prisoner personnel. Technique of traction in fractures of lower femur near knee joint.

FIGURE 16.-Instructional chart prepared for use of German surgeons caring for protected prisoner personnel. Technique of traction in fractures of bones of leg.


As a practical matter, captured German medical officers served, as far as possible, only as ward officers. This limitation was necessary because so many of them were poorly trained. Internal fixation of compound fractures, bone grafts, or pedicle grafts were performed by United States Army medical officers. At one of the large prisoner-of-war hospitals in Normandy, Major Jergesen had some 2,000 compound fractures under treatment, and he himself did the great bulk of the definitive surgery there. The prisoners of war could not be evacuated, as could United States Army wounded, and Major Jergesen did the work that would normally be done for American wounded in Zone of Interior hospitals.

It was generally observed that German military surgeons, when placed in charge of their own wounded, under Allied supervision, were inclined to advise amputation with great frequency, in preference to making prolonged attempts to clear up infection and close wounds, while employing skeletal traction to stabilize fractures. If there was a chance that a badly infected limb could be saved, they preferred to salvage it by the closed plaster method, even though it meant prolonged suppuration.

The experience at the Hôpital de la Pitié in Paris illustrates why careful supervision of German military personnel was necessary. When the 217th General Hospital took over this hospital in 2 detachments, 29 August and 2 September 1944, it was filled almost to capacity with German wounded, who had been left behind with 2 medical officers, 2 nurses, a surgical technician, and a chaplain. Among the wounded were a few American and British prisoners. The incoming staff was impressed with the lack of cleanliness, which was, however, partly explained by the shortages of personnel during the preceding week or two; the paper bandages; the wire ladder splints and metal trough splints, which were widely used instead of more efficient traction; the overgenerous use of morphine; the high incidence of osteomyelitis; and the large number of amputees. In spite of the condition in which the German wounded were found, it was possible, by vigorous treatment, to get most of them ready within a few weeks for safe evacuation to hospitals designated for enemy wounded.

Penicillin.-Since penicillin was in constantly short supply throughout the fighting in Europe, it was given to prisoners of war only when it was indicated to save life and limb, and not routinely, as it was given to Allied wounded after it became available in the spring of 1944. Circular Letter No. 39 directed that it was not to be issued to protected enemy medical personnel. It was, instead, to be kept under the control of United States medical officers, and the commanding officer of each hospital had to approve both the indication and the dosage in every instance in which it was prescribed for a prisoner of war.