A Treatise on Fractures, Luxations, and Other Affections of the BonesDesault, P.-J. (Pierre-Joseph)
Science
A Treatise on Fractures, Luxations, and Other Affections of the Bones
Desault, P.-J. (Pierre-Joseph)
Dislocations; Fractures; Surgery
The patient is, indifferently, either seated or standing. The fore-arm
being half-bent, an assistant takes hold of the extremity next the
hand, to make extension; another, to make counter-extension, takes
hold of the humerus a little below its middle, with both hands, the
fingers crossing before, and the thumbs behind. The extension is
made gradually, and when it begins to move the olecranon, and draw
it from the place it accidentally occupies, the surgeon, to aid in
the reduction, grasps the lower end of the humerus with both hands,
crosses his fingers in the fold of the arm, applies his thumbs to the
olecranon, and drawing the first backward, pushes at the same time the
latter forward; thus, he favours, on the one hand extension, and on the
other counter-extension, and in that way finishes the reduction.
20. This method is most commonly practised with success, in recent
luxations, where we have oftentimes seen the reduction effected at
the Hotel-Dieu, by the simple process of pushing, as just mentioned,
the olecranon forward, the humerus being held backward, without any
previous extension, while the fore-arm was merely supported by the
assistants.
21. But the luxation being oftentimes of long standing, presents
very great difficulties. What means must then be employed? It is an
established principle, that the force with which a power acts, is
in direct proportion to its distance from the point of resistance.
Augment this distance, and the extending forces, being doubled and
even trebled, will more easily dislodge the luxated extremity. But
this indication is fulfilled, by two long straps, formed each of a
towel folded several times, one of which is fixed above the wrist,
and the other round the humerus a little below its middle. Extension
is then made at their extremities, and is almost always sufficient,
when aided by skilful efforts of the surgeon (19), to accomplish the
reduction. The application of a strap round the humerus is never
necessary, unless when the resistance is very great; because, in
counter-extension, it is requisite only to withstand or bear against
the efforts of extension, but not to act in a contrary direction.
22. But in cases of this kind, the strap, placed, as we have directed,
round the lower part of the humerus, has sometimes the disadvantage of
compressing too much the brachialis and the biceps muscles, and thus
preventing them from acting; this inconvenience is particularly felt in
old luxations, where great force is employed; for, the more active then
the contraction of these muscles is, the more it will aid the surgeon
in his efforts to draw the bones into their natural situation, when
once disengaged by extension, from that which they had accidentally
occupied. If, in such a case, we impede the contraction of these
muscles, how can they fulfil this office?
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