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
CASE. Desault had, for a long time, the care of a patient, whose
luxation, having been neglected for four days, was reduced on the
fifth, by a surgeon, who, for the purpose of retaining it, employed
a bandage of a particular kind. An hour afterwards, a motion of the
shoulder backward, displaced the luxated extremity: a new reduction was
the consequence; on the day following, another displacement, and so on
in succession, for ten days, at the expiration of which, Desault being
consulted, applied to the part the bandage formerly described.
On being examined the next day, the apparatus was found in a favourable
state. On the day following, a slight displacement rendered necessary a
new application of the bandage, which, this time, continued longer than
before. But, about the expiration of the third day, the projection of
the bone was again considerable. Finally, the patient recovered, with a
very perceptible protuberance in front of the sternum, and a difficulty
of motion, great at first, but less afterwards, and which exercise
succeeded ultimately in removing.
21. The application of the apparatus differs from that intended for a
fracture of the clavicle, only in this, that it is of service to place
on the luxated extremity, graduated compresses,[7] calculated to make
pressure backward and outward, and which are to be secured by the turns
of the roller (b Fig. 4).
[7] Compresses laid one upon another, of which the upper one is
still the smallest, not in relation to thickness, but as far as
regards length and breadth. TRANS.
A second precaution, not less essential, is, to push the humeral
extremity of the clavicle, a little forward, and fix it in that
direction, in order that the sternal being directed backward, may be
removed from the place[8] through which it has a tendency to escape.
[8] The rupture in the capsule that surrounds the joint. T.
22. Desault almost always obtained complete success by this process,
and by the most accurate attention to prevent the relaxation of the
bandage. In the mean time, a stiffness, more or less considerable,
always remains in the joint for a long time after the reduction, and it
is not unfrequently a month or two before the part recovers its usual
facility of motion.
The following cases, collected by Brochier, confirm the doctrine for
which I have been contending.
CASE II. A man luxated the clavicle by falling on the point of his
shoulder, and forcing it backward. He was immediately brought to the
Hotel-Dieu, where Desault demonstrated to his pupils, that the head of
the bone, carried in front of the sternum, was removed nearly an inch
from its natural cavity, the ligaments of which were no doubt lacerated.
Here, as in the fracture of the clavicle, the application of the
bandage answered the purpose of reduction, and removed the protuberance
formed by the extremity of the bone.
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