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
15. Transverse fractures are less exposed to displacement, in the
longitudinal direction of the bone, because the fragments when in
contact, support each other. In such a case, the inferior fragment,
drawn by the muscles, finds a point of resistance against the superior
one, while the latter, when pressed downward by the weight of the body,
pushes the former before it, and thus both preserve their relative
position.
16. A deformity of the fractured os femoris, in the direction of
its cross-diameter or thickness (9), always accompanies that in its
longitudinal direction, and sometimes exists alone. This takes place
when, in a transverse fracture the two ends of the bone, losing their
contact, are carried, the one outward, and the other inward, or when
the one remains in its place, while the other is separated from it. In
such a case, the superior fragment is not, as in the preceding one,
immoveable by means of muscular action; because the action of the
pectineus, the psoas, the illiacus, and the first adductores, derange
its natural direction, and contribute to its displacement.
17. The deformity of the limb, in relation to its direction, in other
words, the crookedness of the limb (9) is either the result of the
stroke which fractured it, or, what is more common, of the ill directed
efforts of those who lift and carry the patient, and, by an improper
position, bend the two fragments, so as to make them form an angle with
each other. Desault was once called to a patient, whom he found seated
on a bed, in such a manner, that the upper part of the thigh was in a
horizontal position, and the lower, hanging with the leg in almost a
perpendicular one. Doubtless the triceps femoralis, equally attached to
both fragments, bends them by its contraction, and produces a change in
the direction of the limb.
18. Whatever may be the kind of the deformity, whether in a
longitudinal or lateral direction, the inferior fragment may either
preserve the natural position in which it is placed, or experience a
rotatory motion on its axis outwards, which is a common occurrence,
or inwards, a circumstance which is more rare. This rotation always
renders the displacement more serious, and ought to have an influence,
as I shall presently observe, on the means of reduction.
§ IV.
OF THE PROGNOSIS.
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