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
21. The first patient whom Desault visited at the Hotel-Dieu in quality
of surgeon in chief, had a luxation forward, of more than two months
standing, in which the use of these means facilitated the reduction:
but they are sometimes insufficient, and then the radius remains
immoveable, and the forearm performs its motions but partially.
22. It would seem as if nature, always industrious to provide, amid
the disorders of our organs, some resources for the exercise of their
functions, has been desirous of preventing here, the inconvenience
attendant on a failure of reduction, by rendering luxations backward
much more difficult than those forward. Indeed if the fore-arm be kept
constantly in a state of supination, it will be much less useful, than
if it were always in a state of pronation, the situation in which most
of the motions necessary to our existence are performed.
§ VI.
OF THE SUBSEQUENT TREATMENT.
23. When the reduction is finished, the articulating surfaces have
sometimes a great tendency to be displaced, by the different movements
of the fore-arm, a tendency of which we may easily form an idea, if we
observe, that in a state of pronation, the head of the ulna presses
against the back part of the strained capsule, and consequently against
its opening, when the luxation has been forward: a contrary state of
things occurs in a luxation backward. Whence it is always prudent
to avoid, for some time, the motions of pronation and supination,
according to the direction of the displacement.
24. Should the tendency to displacement be very great, it will be
necessary to adopt the simple method pointed out in a case already
published by Desault.
CASE I. The case was a luxation forward, which was easily reduced.
But the easier the reduction, the more difficult was it to retain the
replaced parts. This was at length accomplished, by fixing the fore-arm
in a state of supination, and applying one thick compress behind the
ulna, while the radius was pushed backward by another compress, placed
on its anterior part, both secured by a common roller. This apparatus
was continued for the space of a month, after which the reduced bones
remained in their natural situation. The patient began, at first, to
perform gentle motions of the wrist, avoiding those of pronation, on
which he afterwards ventured by degrees, and with great caution.
25. These gentle motions frequently repeated, when a displacement is
no longer to be apprehended, remove that unavoidable rigidity which,
for some time, occupies the parts around the joint. It is advisable,
for some time, to apply on the hand and extremity of the fore-arm,
compresses wet with some discutient liquor, to prevent the swelling
resulting perhaps from the inactivity and sprain of the parts. This was
the practice of Desault.
I will close this memoir by two cases, extracted from the Journal of
Surgery, in order to confirm, by experience, what has been already
settled in theory.
Public-domain text, read in full here on John Shaqi.
Reviews
Reviews
No reviews yet
Be the first to share your thoughts on this work.
Elsewhere in the archive
Join the Discussion
Join the discussion
Sign in to leave a comment or review.
Sign InorCreate an account