A Treatise on Fractures, Luxations, and Other Affections of the Bones — John Shaqi
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
17. The figure of 8 bandage, so generally in use, and all the various
modifications, under which it has been revived, without being
improved, fix the clavicle in the very direction most favourable to a
displacement, and even do it in the very manner in which that accident
is sometimes brought about; as maybe seen in the history of the case of
the porter (6). This bandage does not, under any of its modifications,
prevent the motions of the shoulder, because it does not restrain those
of the arm, which remains free and unencumbered. Far from constituting
an antagonist power to, it even co-operates with, that which has
produced the displacement. (For further light on this subject, see what
has been already said on the fracture of the clavicle, pages 22 and 25.)
Bell, in condemning the figure of 8 bandage, not so much because of its
action being insufficient, as because of its obstructing respiration,
proposes, as a substitute for it, a kind of machine analogous to the
iron cross of Heister, which, being fixed by straps passing under
the arm-pit, and round the neck and body, is intended to retain the
parts firm and immoveable. But the motions of the arm not being
restrained, nor the action of the muscles of the shoulder opposed by an
antagonizing power, places this piece of apparatus in the same class
with those, which, from not being devised and constructed on a proper
view and conception of the causes of displacement, have no affinity to
rational practice.
18. The apparatus for a continued extension, invented by Desault, for
fractures of the clavicle, fulfil here all those indications in which
the others fail.
By this, 1st. The aim, being firmly fixed against the side, by means
of the roller (_c c_ Fig. 3), can communicate no motion either to the
shoulder, or the clavicle. 2dly. The shoulder itself, being forcibly
drawn outward, with the upper extremity of the humerus, by the action
of the kind of lever into which this bone is converted, and to which
the bolster (_a b_ Fig. 1) serves as a fulcrum, cannot, by its
movements, derange the luxated bone. 3dly. The sternal extremity, being
drawn both by the muscles which tend to displace it inwardly, and by
the bandage which acts on it in an opposite direction, remains fixed
between those two antagonizing forces, which thus destroy each other.
Hence the apparatus of Desault, when accurately applied, offers to both
of these powers of displacement, a resistance perfectly calculated to
combat them.
20. We must, however, admit that this apparatus partakes of one
inconvenience, common indeed to all bandages, but which is perhaps more
particularly applicable to this in consequence of the numerous casts
of the rollers that form it, namely, the great facility with which it
becomes relaxed. Hence one cause of displacement, which the most exact
and scrupulous attention cannot at all times prevent.
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