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
The muscles of the thigh, by means of violent contraction, had drawn
that portion of the os femoris attached to the external condyl upwards,
and the superior fragment downwards. The sharp point of the latter had
passed through the skin, and produced a wound of an inch and a half in
extent, on the inside of the thigh, and a little above the condyl.
The patient being undressed, was placed on a bed nearly horizontal, on
which had been previously spread the necessary pieces of apparatus,
disposed in proper order. Desault then examined the wound, extracted a
splinter of the bone, covered the wound with lint, and then proceeded
to the application of the apparatus which he usually employed in such
cases (128).
The extension was accompanied by no pain: on the other hand, it gave
immediate relief: diluting drinks were prescribed. Next day, no pain;
pulse a little raised; no dryness, nor any alteration of the skin; diet
the same as on the preceding day; the apparatus wet with vegeto-mineral
water. Fourth day, a new application of the apparatus, which had become
relaxed; appearances of suppuration.
From this time the dressing was renewed every other day, till the
sixteenth, when the wound was cicatrized. After this the apparatus
was not touched except when deranged; it was only wet from time to
time with vegeto-mineral water, and great pains were taken to keep up
the extension. The apparatus was not laid aside till the sixty-fourth
day, although the callus appeared to have acquired a state of solidity
somewhat sooner.
The patient was soon in a situation to take exercise. The stiffness
then disappeared rapidly, and, in about three weeks, he left the
hospital, able to bend the leg to a right angle with the thigh, and
under a full confidence that he would in a short time regain all the
motions of the limb.
§ XXII.
OF THE SUBSEQUENT TREATMENT.
131. As soon as the consolidation is complete, the motions of the
limb must commence. These, at first gentle and confined, must be
afterwards, increased in extent, and more frequently repeated, till, at
length, the limb should be exercised every day for two or three hours
without intermission. The position and direction of the leg ought to
be constantly changed. One while, the thigh should be elevated by a
bolster, so as to flex the leg; at another time, the bolster should
be fixed under the leg to keep it extended. The rotula must be moved
in every direction, and, as soon as the patient can leave his bed, he
should take exercise himself. These precautions are more necessary here
than in any other fracture, because a stiffness of the parts adjacent
to the joint, is always the inevitable consequence of a long state of
rest. Certainly writers would not have considered anchylosis as the
most favourable termination of such fractures, had they been acquainted
with the effect of exercise and rest in that now under consideration.
Public-domain text, read in full here on John Shaqi.
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