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
33. This first part of the bandage evidently fulfils the third and
fourth indications (18). The compression of the roller on the muscles
weakening their action and impeding their motions prevents their
tendency to draw the superior fragment upwards: while the circular
casts passed behind this fragment, acting in opposition to the
muscular contractions, prevents it from moving upwards in obedience to
them. The long compress-roller, stretched on the fore part of the limb,
being first secured below, and then drawn forcibly upwards, presses
the casts of the roller against each other, and prevents those that
correspond to the thigh from slipping upwards, and thus abandoning the
superior fragment, and prevents also those on the leg from slipping
down and withdrawing their support from the inferior fragment. As there
remains no vacant space between the circular turns, their pressure is
uniform throughout: no swelling can consequently supervene (20).
34. But the first and second indications remain still to be fulfilled
(18): it is necessary to prevent the separation of the lower fragment,
by the extension of the leg on the thigh, and to throw the muscles into
a state of relaxation by extending the thigh on the pelvis, and to
maintain permanently, by the apparatus, that double position, which the
assistant maintains only during the operation.
35. To obtain the first effect different means have been employed; but
none answers so well, to extend the limb and retain it immoveably in
that state, as a long and strong splint, placed, as Desault did it,
subsequently to the application of the first part of the bandage, along
the posterior part of the limb. An assistant must hold the end of this
splint, while the surgeon secures it in its place by the second roller
(31): in this way the extension of the leg is effected.
36. To obtain the extension of the thigh, it is necessary to place on
the top of each other, two or three bolsters or little bags filled
with chaff, so disposed as to form an inclined plain, considerably
elevated towards the heel above the level of the bed, but which,
gradually descending to the same level towards the tuberosity of the
ischium, forms a supporting basis on which the whole limb may rest in a
uniform manner. By this twofold extension of the leg and of the thigh,
the lower fragment is kept up immoveably, and the muscles are kept in a
state of relaxation.
Hence it follows, that this bandage fulfils extremely well the
conditions laid down (18), and that it ought to be preferred to all the
others (19 ... 25), which answered the indications only in part.
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