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
128. Permanent extension, made in the manner already mentioned (60 ...
63), fulfils the two first indications; while two lateral splints, and
the bandage of strips fulfils the third. Desault, therefore, applied to
this particular case his apparatus for permanent extension, modified
only in such a way, that, instead of terminating at the knee, the
bandage of strips was continued to a distance down the leg, in order
that its action might be the more efficacious. For, it is well known,
that it is at its middle part that the firmness and retentive power of
a bandage are greatest, because the casts of the roller at the upper
and lower ends, serve to secure those in the middle. The upper splint
being altogether useless, was not employed.
129. If the superior fracture be transverse, the condyls, as I have
already said, meet with resistance against the body of the bone, while
they, on the other hand, support it in such a manner, as to prevent
it from descending, though pushed by the weight of the body along the
inclined plain made by the pressure of the nates. Here, then, permanent
extension is generally useless, and all that is necessary is, to retain
the condyls and prevent their separation by means of lateral pressure.
The same apparatus may still be employed, provided the two rollers for
extension be laid aside.
130. If a wound in the soft parts accompany the fracture, whether it
be produced by the same cause, or by the subsequent passage of the
fragments through the integuments, and whether it communicate with
the articulation or not, it is necessary, as soon as suppuration has
taken place, to renew the dressings every day or every other day,
taking care, in the mean time, to supply, by the hands of an assistant,
the want of extension by means of the apparatus. The following case,
extracted from the Journal, exhibits a specimen of the treatment that
ought to be adopted in similar cases.
CASE XI. Claudius Legrange, aged thirty-one, and of a sound
constitution, was wounded by the kick of a horse, on the internal
condyl of the left os femoris. The violence of the pain obliged him to
throw himself on a heap of straw, that lay at a little distance, and
which he reached by hopping on his right foot. The pains were augmented
by this, for at each step, the thigh being alternately bent or extended
at the injured part, was moved sometimes backward and sometimes
forward. The patient was brought to the Hotel-Dieu, a few hours after
the accident.
The signs already specified (121 and 122) announced to Desault, a
longitudinal fracture separating the two condyls, and terminated above
by another fracture of the body of the bone, which descended obliquely
from about five inches above the external condyl, to within two inches
of the internal one.
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