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
6. The situation of the leg, gently flexed by means of a thick cushion
or pillow placed between it and the mattress, is, in all respects to
be preferred to the method of Pott, which is exclusively adopted by
Bell. What, indeed, can be the object of this latter method? To relax,
say they, the muscles, that tend to make the lower fragment overlap
the upper one. But is it not evident, that most of these muscles, not
being attached to the os femoris at all, cannot be influenced by this
position? To obtain the relaxation of the posterior muscles, it is
necessary to flex the foot; but, in such a case, the anterior muscles
are necessarily in a state of tension: this completely counter-balances
the relaxation of the others, and, therefore, there is nothing whatever
gained. It is certainly much best to allow the leg to be in a state of
moderate flexion, such as we assume when asleep, and which appears to
be the most natural.
7. The apparatus just described, produces on the fragments a twofold
action: 1st, by a kind of side walls formed by the splints, it prevents
their displacement laterally, and from this circumstance alone, is
fully sufficient for the retention of transverse fractures: 2dly, the
pressure of the rollers, splints, and bolsters, if these be applied
with sufficient tightness, prevents the lower fragment from mounting on
the upper one, and thus preserves the natural length of the limb. Hence
its advantages in oblique fractures; and, as the powers of displacement
are weaker here than in the thigh, this apparatus, is in general,
sufficient to counteract them.
8. It is true that cases do sometimes though rarely occur, where,
in consequence, of being irritated by splinters, or the points of
the fractured bone, or acted on by some other causes which make them
contract, the muscles overcome the resistance of the apparatus, and
make the fragments overlap. Under such circumstances, permanent
extension affords here the same advantages as in fractures of the thigh.
9. Most authors, to obtain the desired end in such cases, recommend
means calculated to act on the thigh. Thus, Manne proposes the use
of his glaussocome. Desault, under such circumstances, effected his
purpose by the apparatus described in the following case.
§ II.
10. CASE II. Pierre Bejol, aged thirty-seven, of a strong and vigorous
constitution, fell, as he was carrying a heavy load, over a beam which
lay in his way. His leg was fractured towards its lower part; he
was lifted up and carried home, where a surgeon, by making unskilful
efforts at reduction, gave him extreme pain.
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