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
6thly, Should the long compress prove insufficient to keep the foot
extended, or should it, by becoming relaxed too soon, render frequent
reapplications of the apparatus necessary, (circumstances which rarely
happen when the bandage is well applied), a splint placed anteriorly,
as was the case in Schneider’s apparatus (29), completely remedies the
defect.
33. On comparing this apparatus with the indications formerly laid
down, in the present disease (16), we find it evidently calculated
to fulfil them with great exactness. 1st, The extension of the foot
is permanently secured, both by the long compress, and by the splint
when it is employed: 2dly, the same compress, aided by the bolster or
pillow placed under the leg, maintains the flexion of the leg on the
thigh: 3dly, The muscles are effectually compressed; their action is
impeded in part by the compression of the circular bandage, which does
not bear on the tendon, in consequence of the bolsters of lint placed
on each side of it: these bolsters prevent the tendon both from moving
laterally, and from being depressed: hence it follows, that the action
of the circular bandage is precisely conformable to the principles
already established (14 and 15); and that the whole of the apparatus,
taken together, fulfils perfectly all the indications (16); this is an
advantage not to be derived from any of the forms of apparatus used by
preceding authors.
34. This apparatus is in no degree complex or troublesome. Simple and
easy, it requires nothing for its construction but what the surgeon
can easily obtain, and what he can even himself prepare. There exists
a great analogy between it and the bandages which Desault used for the
reunion of transverse wounds, and for fractures of the rotula and the
olecranon. A truly great man does not estimate his merit, by the number
of processes which he invents; he well knows that the perfection of art
consists in producing numerous effects by few and simple means.
35. We will confirm, by two cases, the principles laid down in this
memoir. One of these relates to a division of the tendon, connected
with a wound, and was reported by Bezard; the other by Manouri, and
relates to a simple rupture of the tendon.
CASE I. J. B. Lavigne, aged thirty, as he was going down into a cellar
without light, struck his leg against the edge of a sharp saw, which
completely divided the tendo Achillis. The patient was immediately
carried to the Hotel-Dieu. The wound of the integuments was transverse,
two inches long, and had its edges but slightly separated from each
other. The ends of the tendon, in contact during the extension of the
foot, were separated two inches when it was flexed.
The usual apparatus was applied (32), and the limb placed on a bolster,
in a position favourable for the relaxation of the posterior muscles.
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