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
12. To this example, I might add many others, where similar
displacements, properly treated, terminated with equal success: no
pain; no swelling; no inflammation; and therefore, of course, no
mortification. Yet these are occurrences of which authors speak, as if
they were the usual consequences of such luxations, where, to a violent
injury done to the soft parts, is added a fracture near to, or even
communicating with, a joint. The erroneous opinions of the ancients and
most of the moderns, respecting the dangers arising from such vicinity
or communication, have contributed not a little to their unfavourable
prognosis in the cases under consideration. Should the patient survive
the disease, his inevitable lot, according to them, must be, a complete
anchylosis of the leg with the foot. But, the preceding cases fully
prove, that this apprehension is unfounded. A considerable time is
doubtless necessary, for the recovery of motion, on account of the
distension and rupture of the ligaments, the long continued inactivity
of the parts, and the swelling which they have undergone. But this
recovery can always be effected by means of exercise, gentle at first,
increased afterwards, and regulated according to the principles so
frequently laid down in the course of this work. Much more to be relied
on is such exercise, than the long catalogue of discutient means, such
as pumping of water on the parts, alkaline baths, mineral waters, and
all other external applications, so often extolled as efficacious, and
so often found entirely useless.
§ III.
LUXATION OF THE FOOT, COMPLICATED BY A SEPARATION OF THE BONES OF THE
LEG, AT THEIR LOWER END.
CASE III. (The following case was reported by Thevenot). I. Joseph
Schneider, an ebonist, aged thirty-six, as he was walking in haste, on
the 23d of March, 1792, fell forward, his foot being forced backward
and outward. He experienced at the instant severe pains in the joint:
he was unable to rise, and was therefore carried home, where a surgeon,
after making a slight extension, applied a roller on the limb, and
did nothing further. The patient experienced no relief. The pains
increased; a swelling supervened; convulsive motions began to occur;
and the patient was brought to the Hotel-Dieu, six days after the
accident.
From the deformity of the foot, Desault immediately discovered that it
was luxated. Its point was directed outwards, while its sole was turned
in the same direction: beneath the malleolus internus, which was too
prominent, was a tumour formed by the astragulus. The crepitation of
the bones which was easily heard, the preternatural distance between
the tibia and the fibula, the mobility of this latter bone, and the
absence of the signs of a fracture, plainly showed that a separation of
the two bones of the leg had taken place.
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