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
1. CASE I. (Reported by Levacher). Catharine Belet, aged fifty-five, of
a strong and vigorous constitution, fractured her leg in the middle,
by a false step in alighting from a carriage. Being carried home, in
a careless manner, she was visited by a surgeon, who merely reducing
the fracture, but applying nothing to retain the reduction, sent the
patient to the Hotel-Dieu. She was conveyed on the same day to the
amphitheatre, where Desault discovered the existence of the affection
by the following signs.
Pain in the middle of the leg, less severe when the limb was at
rest, more so when it was suddenly moved; the patient absolutely
unable to support herself on it so as either to stand or walk since
the accident; inequalities sensible to the touch on the anterior
surface of the tibia; a shortening or contraction of about half an
inch; a preternatural mobility at the place of the fracture; evident
crepitation, produced by the rubbing of the fragments against each
other, when moved in contrary directions: a change in the direction
of the lower fragment, which was bent somewhat outwards. These signs,
added to the circumstance of the fall, evidently announced a simple
fracture of both bones. The reduction was effected in the following
manner.
One assistant made counter-extension by grasping the lower part of the
thigh with both his hands, the fingers being placed behind it, and his
thumbs corresponding to its anterior surface. Another made extension,
not as writers recommend, at the lower part of the leg, but on the foot
itself, which was taken hold of in such a manner that the fingers met
on its upper side, while the thumbs crossed each other on its sole. In
this way a lever of the first kind was formed, the resistance to which
was the fragment to be replaced, while its centre of motion was in the
joint.
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