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
27. In relation to carrying the shoulder backward it loses half of
its effect, because, its force being decomposed (so to speak) by the
obliquity of its direction, is divided into two channels. One of these
runs parallel to the shoulder and acts to no purpose, while the other,
being perpendicular to it, is alone effective; hence it must act with a
force equal to 10, in order to produce an effect equal to 5.
28. The indication, to draw the humeral fragment outward, far from
being fulfilled, is here diametrically counteracted. The scapula, being
approximated to that of the opposite side, draws the humeral fragment
towards the trunk, making it underlap the internal one, and, in this
respect, the figure of 8 bandage acts posteriorly in precisely the same
manner, during the treatment, that the contractions of the muscles did
anteriorly before the reduction.
29. Should the shoulder be supported, at such an elevation, as might
have a constant tendency to destroy the influence of its own gravity?
this is evidently prevented by the very oblique direction of the turns
of the bandage. Suspending the arm in a sling, is the only way, in
which that end can be attained. But does this mode always possess
sufficient firmness and stability? The arm, not being here sufficiently
fixed, may be constantly in motion, which, by deranging its situation,
must communicate very troublesome and injurious movements to the
fragments of the clavicle. One of the principal faults of all bandages
consists, in not preventing these movements, by restraining the
movements of the arm.
To the other disadvantages of this mode, need I add that of its making,
by the turns of the bandage, an undue compression on the projecting
edges of the arm-pit, and producing thereon troublesome and painful
excoriations?
30. From the want of a mutual correspondence and fitness between the
indications already enumerated (20), and the manner in which the
figure of 8 bandage acts, it is evident that the former can never
be satisfactorily fulfilled by the latter. Hence we may judge, what
improvement the art has received from the iron cross of Heister,
the compress of Petit, drawn transversely over the oblique turns of
the bandage, the waistcoat which Brasdor fastened round the thorax
of his patients, and the leathern apparatus, lately proposed by a
German practitioner. These means, though diversified in their form,
are similar in their effect, and, being nothing but modifications of
the figure of 8 bandage, possess, like it, the radical fault of not
offering a resistance directly opposed to the two-fold power, arising
from the muscular action and the gravitation of the shoulder.
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