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
41. Bandages will do nearly as much harm as good in fractures of the
os femoris, if, as was practised by the ancients, they be formed
by a single roller surrounding the limb: in such a case, the limb
being necessarily raised up at each time of their reapplication,
will be exposed to continual displacements. Hence the ingenious
idea of applying to simple fractures of the lower extremities the
eighteen-tailed bandage, invented for compound fractures, and by means
of which the thigh may be suffered to remain at rest. But to this
bandage belongs also an inconvenience. The pieces which compose it,
being stitched together, cannot be separated, and if one of them be
soiled they must all be changed. Hence the superiority of the bandage
of slips, known in former times, and engraved by Scultel, but long
since forgotten, till Desault revived the use of it, and adopted it
exclusively, both in simple and in compound fractures.
42. Splints of different kinds, which form the second division of the
pieces of apparatus, used for fractures of the os femoris, have the
advantage of fixing the limb in a solid and firm manner, and securing
it from any displacement that might result from jolts, or muscular
contraction, arising from the inattention of patients: these prevent,
more effectually than bandages, any displacement laterally, and, on
this account, their use is sufficient, even without extension, in
transverse fractures: they also prevent, particularly if they be made
of wood, the rotatory motion of the thigh either outwards or inwards
(18). But if the division be oblique, will they prevent the gliding of
the fragments over one another, and the consequent shortening of the
limb? They can evidently produce this effect in no other way, than by
the forcible pressure made by the pieces of apparatus, particularly
by the straps or bandages that secure the splints, and then, to
make effectual resistance, it would be necessary to apply them with
such a degree of tightness as would endanger the life of the limb.
Will splints prevent the trunk from sinking downwards, and pushing
the superior fragment before it? Will they prevent the muscles from
acting on the lower fragment? Can they, in a word, fulfil all the
indications formerly pointed out (28)? Certainly they cannot. Splints,
then, are calculated only to prevent displacement in the lateral or
cross direction of the bone, and to secure, better than bandages, the
immobility of the limb. Whence it follows, that they ought not, in
this case, to be confined to the thigh alone, but should extend to the
leg, whose movements, if communicated to the os femoris, may derange
the contact of the ends of the bone. The neglect of this precaution,
contributed formerly not a little to displacement and deformity.
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