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 reduction was immediately effected by means of extension and
counter-extension, and was announced when it took place by a report
distinctly heard. It was then retained by a bandage, calculated to
answer a twofold purpose; 1st, to approximate, and keep together, the
two bones of the leg: 2dly, to secure the contact and immobility of the
bones of the foot.
Blood-letting was prescribed: an anodyne mixture administered; low
diet; in the night severe pains were felt; next day, they were
increased; on dressing the limb, nothing amiss discovered; all the
parts in perfect contact: no vestige of separation between the tibia
and the fibula: a new apparatus applied; and kept constantly moist.
Third day, the patient better: fifth day, the fibula a little separated
from the tibia: the circular bandage drawn tighter to reduce it to its
place again. Tenth day, every thing in its natural state: no pains:
swelling gone. Fifteenth day, a simple roller substituted in place
of the bandage for a fracture of the leg. Nineteenth day, the patient
began to walk, with the assistance of a stick: twenty-third day, walks
easily: twenty-eighth day, is dismissed perfectly cured, and nearly
free in all his motions.
13. The separation of the bones of the leg, at their lower end, does
not constitute a very serious complication of luxations of the foot,
although the contrary is asserted by several authors. Desault met
with this accident several times in the course of his practice, but
never saw it terminate otherwise than favourably. But here, as in all
other cases, the most minute attention is necessary to ensure success,
the want of which is more frequently owing to the negligence of the
surgeon, than to the deficiencies of the art. The bandage employed
after reduction ought to act principally from without inwards, and in
a direction perpendicular to the axis of the lower part of the leg, in
order to approximate the two bones. It will be of some service, in this
respect, to place on each bone a compress, which, projecting more than
the rest of the circumference of the limb, will be more compressed, and
on that account, contribute to the end in view.
§ IV.
LUXATION OF THE FOOT, ACCOMPANIED BY A DISPLACEMENT OF THE ASTRAGULUS
AT ITS ARTICULATION WITH THE OS SCAPHOIDE.
14. Petit never met with more than two instances of that displacement
of the astragulus, now under consideration. His general prognosis on
the subject is more favourable than that respecting other luxations
of the foot, with which he never saw the present luxation of the
astragulus complicated, as occurred in the following cases. Had such
complex cases fallen under his notice, there can be little doubt, but
he would have declared amputation to be the only recourse of art on the
occasion.
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