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
A roller and a kind of round splint applied to each side of the
limb, forming the whole of the apparatus, and not being sufficient
to retain the fragments, soon allowed them to overlap each other
nearly two inches. The pains continue; a considerable swelling appears
around the fracture; the patient is greatly agitated; he is brought
to the Hotel-Dieu, where, from the deformity of the limb, Desault
was satisfied, at first sight, of the existence of a fracture; on a
more attentive examination, it was discovered to be complete and very
oblique.
The muscles being tense and in a state of violent contraction, drew the
inferior fragments very forcibly upwards; these were finally, however,
by means of well directed efforts, brought into perfect contact,
with the superior fragments: the difficulty now lay in maintaining
this contact. The age of the patient, his strength, and the almost
convulsive state of the muscles, gave reason to apprehend that a
displacement was about to occur. An attempt was made to prevent this in
the following manner.
The patient being laid on a bed properly prepared,
1st, The foot and the leg above the ancle, were covered by a bolster
or compress, round which was passed a strong roller intended for the
purpose of making extension. The ends of this roller, being left free,
were carried, one on the outside, and the other on the inside of the
limb.
2dly, Below the tubercle of the tibia was placed another bolster,
surrounding the leg, and on this, was secured another roller for the
purpose of counter-extension. The ends of this roller, after crossing
under the knee, were left hanging loose one on each side of the limb.
3dly, The two rollers being thus arranged, while the assistants, still
continued to make extension, the surgeon applied successively, and in
the order already mentioned, the compresses, the bandage of strips, and
the bolsters.
4thly, He then took two splints with notches in their lower ends, of
the same breadth with the splints already described, but long enough to
reach, each of them, from four inches above the knee to the distance of
four inches beyond the sole of the foot. One of these was applied on
the outside and the other on the inside of the leg.
5thly, The surgeon then taking hold of the two ends of the upper
roller, drew them over the upper ends of the corresponding splints,
while an assistant crossing the two ends of the lower roller under
the sole of the foot, drew the external end over the lower extremity
of the internal splint, and the internal end over the lower extremity
of the external splint. Carrying them, then, up along each side, he
brought them, at the middle of each splint, to meet the ends of the
upper roller, to which they were firmly secured by knots, so as to
make extension at the foot, and counter-extension at the knee. The two
fragments, being drawn by this apparatus, the one down and the other
up, could not again overlap.[36]
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