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
2. This case, which is in no respect different from those that most
frequently occur in practice, presents us with a view of the mode
of reduction, the means of retention, and the subsequent treatment,
employed by Desault, in cases of the kind. The advantage of the
bandage of strips, which allows the limb to be uncovered without being
disturbed, is now generally acknowledged in fractures of the lower
extremities. In the treatment of these, practitioners reject entirely,
at present, the roller bandage, which was recommended by Petit,
Heister, and all the authors who preceded them, and which, by producing
a new displacement, at each time of reapplication, may entirely prevent
the fragments from uniting. The bandage of Scultet, brought into use
again by Desault, the form of which has been just described, is also
preferable to the eighteen-tailed bandage, which some practitioners
still employ.
3. The strips which compose the former bandage, being narrower than the
tails of the latter, can be more neatly applied to the leg, as they
more readily mould themselves to its inequalities; the compression made
by them is, therefore, more exact, more uniform, and consequently less
inconvenient. If one of the strips become soiled, it can be changed
without deranging the bandage. (Respecting this point, see what was
said on fractures of the thigh.) This bandage being less bulky than the
eighteen-tailed one, is therefore less troublesome to the patient.
4. The broad and strong splints which form a part of this apparatus,
have the following advantages over those previously used both by the
ancients and the moderns; 1st, they come in contact with and bear on
a larger extent of the surface of the limb; 2dly, they consequently
maintain the fragments in apposition with greater firmness and effect;
3dly, they prevent the rotation of the foot outwards, an accident
which very frequently occurs when the fracture is complete, that is,
when both bones are broken; 4thly, they remain constantly in their
place, without slipping either forward or backward, an inconvenience
necessarily attendant on the other splints, which, from their roundish
form, touch the limb in only one point or line.
5. To sustain the foot, Petit recommends a piece of a board to be
applied immediately to its sole, and supported by two bits of tape
fastened to the splints. This practice is adopted to some extent
even at present: but a simple roller, applied in the manner already
mentioned, is sufficient for the purpose; the tendency of the foot to
turn outwards is never so strong as not to be effectually resisted by
this expedient: besides, should the piece of board be placed ever so
little too vertically, it retains the foot in a state of inconvenient
and painful flexion.
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