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
18. It is evident from the foregoing principles, that every bandage
intended to retain a transverse fracture of the rotula, ought to
be calculated to maintain the following state of things: 1st, the
extension of the leg on the thigh; 2dly, the flexion of the thigh on
the pelvis; 3dly, a uniform compression over the whole limb; and,
4thly, some mechanical resistance properly secured above the superior
fragment: the three last expedients relate to the displacement of that
fragment alone; while the first has a relation to that of the lower
one. Let us examine whether or not the bandages, hitherto employed by
different authors, be calculated for these purposes.
19. M. Valentin, believing that position alone was sufficient to retain
the fragments in contact, neglected the application of apparatus
entirely, which he even considered as hurtful, in consequence of the
swelling it produced; but experience soon proved the insufficiency of
this method. The slightest movement, or the least effort on the part
of the patient, made the extensor muscles contract, which, drawing
the superior fragment upwards, separated it from the lower one; and,
as the time of reunion is in direct proportion to the distance of the
fragments from each other, it must, under such treatment, have been
necessarily tedious, and sometimes must have even failed altogether.
20. As to a swelling being produced by the bandage, this never occurs,
unless when some openings are left, through which the integuments
protruding become tumefied: but, when the pressure is uniform
throughout, when the fluids find throughout an equal resistance, this
accident is not to be apprehended, as is proved by the practice of
Desault, who never met with it; on the contrary, a bandage properly
constructed and applied, is calculated to prevent swelling (16).
Mere position, then, though always of service in this affection, is not
alone sufficient, because it fulfils only the first of the indications
or principles laid down with respect to every form of apparatus for
transverse fractures (18), namely, that which relates only to the lower
fragment; while those that relate to the upper one, remain still to be
fulfilled.
21. Most authors have employed, with a view to these, a kind of figure
of 8 bandage, known in art by the name of _Kiastre_,[32] and approved
of by Petit, Heister, &c. This is made of a roller formed into two
balls, which are brought across each other alternately under the ham,
passing over two hollow or forked compresses, that enclose the two
fragments of the rotula.
[32] I know not of any English term equivalent to this. T.
Public-domain text, read in full here on John Shaqi.
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