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
16. All kinds of apparatus for fractures, being nothing but resistances
opposed by art, to the powers which produce displacement, it follows,
that they should all act in directions precisely opposed to the
directions of those powers. But, we have seen (7), that, in the present
case, these powers are, 1st, the action of external bodies, favoured
by the extreme mobility of the arm and shoulder; 2dly, the action
of the latissimus dorsi, the pectoralis major, and the teres major,
which carry the inferior fragment inward, or, what is more common, of
the deltoid muscle, which draws it outward; 3dly, the contractions of
the muscles of the arm, which have a slight tendency to draw the same
fragment upwards.
17. Therefore, 1st, to render the arm and shoulder immoveable; 2dly, to
carry the upper end of the lower fragment outward or inward, according
to the direction in which it is displaced; and, 3dly, to draw this
fragment downward, are the three indications that ought to be fulfilled
by every bandage intended for a fracture of the neck of the humerus.
The last merits less attention than the other two, because, as already
observed, the weight of the limb alone is nearly sufficient to answer
it.
18. Let us inquire, whether or not the kinds of apparatus, hitherto
employed, have been adequate to the fulfilment of these indications.
The ancients, in obedience to the precept of Hippocrates, fixed the
arm against the breast, and confined it there by a bandage recommended
by Celsus, and constantly employed by Paul of Egina. “_Præstat antem_,
says he, _brachium, ad thoracem moderate deligare, ut ne, si id
commoveatur, figuram avertat_.” Pare still preserved this process,
which the moderns have now entirely abandoned, and which, taken alone,
could properly fulfil only the first indication. The second indication
was less happily fulfilled, by a kind of bandage added to the first,
by Celsus, Paul of Egina, and the Arabians, the necessary effect of
which was, to force the lower fragment outwards. It is surprising that
Heister and Lamotte should have confined themselves to the use of this
for the retention of the fragments.
What shall we say of the eighteen-tailed bandage exclusively adopted
by Petit and Duverney? The arm, not being fixed by it, was liable to
be moved, and the fragments to be displaced by the least shock. There
was nothing to prevent the lower fragment from obeying the powers
tending to carry it either inward or outward. Indeed the bandage was of
no avail whatever in giving support to a fracture, as was observed by
Louis, in his “Dissertation on Petit’s Diseases of the Bones.”
Suppose the arm, as some have advised, to be supported only by a sling.
Not one of the indications just established (17) could by such means be
fulfilled.
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