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
39. If to these indications we compare the mode of action of the
different pieces that unite in composing our common forms of apparatus
which do not make permanent extension, such as common bandages,
splints, compresses, bolsters, &c. we will perceive that they are
but ill calculated to fulfil them: and first of bandages. Whether
the common roller, or the eighteen-tailed bandage be employed,
their mode of operation is the same: their only action is, to add a
second exterior and artificial covering to the natural cutaneous and
aponeurotic covering of the thigh; to press against the fragments
the muscles which form for them a kind of natural case intended
to keep them in apposition; and to augment, by this pressure, the
lateral resistance of the soft parts. By this contrivance, lateral
displacements will, in part, be well guarded against, and, in this
respect, these bandages are useful in transverse fractures. But what
is there in them to prevent the two inclined plains of an oblique
fracture from sliding on each other? What provision is there in them
to secure the limb from the effects of motions and shocks which may
be accidentally impressed on it from without? Will the pelvis be kept
steady by them? or will muscular action be sufficiently checked and
kept under by them? The force of the muscles will indeed be slightly
diminished by means of compression; and to make this compression is
the principal use of these bandages in oblique fractures. But will mere
compression be sufficient to prevent a displacement in the longitudinal
direction of the bone, particularly if the rollers be slack, as certain
practitioners recommend, on the ground of the fallacious theory of
Duhamel, who conceived, that a constriction too tight, would injure the
action of the periosteum, which, according to him, is the sole agent
in the formation of callus? So much, then, for bandages, whose only
use is to prevent, by compression, the swelling of the limb, and to
diminish, in some degree, the contraction of the muscles, which they
press against the fractured bone.
40. These remarks apply equally well to the use of compresses; which
make but a very feeble resistance against a powerful cause, and cannot
be considered as any obstacle whatever to displacement. What can be
said of those surgeons who, from servile attachment to a particular
form of apparatus, do not consider a fracture as reduced, unless a
certain quantity of compress secured by a given quantity of roller, be
applied on the limb. Servile imitators in an art which calls for genius
in its votaries, they are only capable of following, without reflection
or judgment, the steps of their predecessors.
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