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
14. Every thing being arranged, the reduction is effected in the
following manner. One assistant is directed to make extension at the
upper part of the arm, which he grasps with both his hands; another
makes extension on the fore-arm half-bent, which he uses as a lever
of the second kind,[12] where one of his hands, being placed under the
wrist, forms a fulcrum, while the other applied towards the fold of
the arm, represents the power. The surgeon, in the mean time brings
the condyls together, adjusts their level and apposition, both between
themselves, and with the body of the bone, and then proceeds to the
application of the apparatus, the limb being still kept in a half-bent
position, as was long since recommended in such cases by Paul of
Egina. “_Si in vicinia cubiti brachium fractum est, etiam ipse cubitus
deligandus, angulari figura servata._”
[12] In this form of lever, the power is applied between the
fulcrum and the weight to be moved, or the resistance to be
overcome. TRANS.
15. The roller (13), wet with vegeto-mineral water, which facilitates
its application, and prevents the swelling of the part, is fastened
by one of its ends, about two-thirds down the fore-arm, and continued
upwards by oblique and reverse casts, to the joint. The surgeon then
passes a cast of the roller from the anterior and superior part of the
fore-arm, to the posterior and inferior part of the arm (humerus),
redescends by an oblique cast from the other side, over the fore-arm,
and returning along the first track, makes a number of casts in the
form of the figure of 8, round the joint, which he next covers by
circular casts, applied so close to each other, as to leave no opening
between them; he then proceeds upwards by oblique casts, as at the
first, to the middle part of the arm (humerus), when the roller is
given into the hand of an assistant.
The first of the splints (13) is now placed anteriorly on the fore-arm
and arm, and, if it does not bend, in such a manner, as to accommodate
itself to the fold of the arm, the vacant space beneath it is filled
up with compresses, laid on top of each other, so as to make its
compression uniform throughout. The second, being applied on the
posterior side part of the arm, moulds itself to the projection of the
elbow, while the other two occupy the sides. These are secured below by
an assistant, while the surgeon resuming the roller, which he had just
given out of his hand, fixes them firmly by circular casts descending
along the arm and fore-arm.
The limb is then laid on a pillow, so disposed that the hand may be
raised higher than the elbow, in order to prevent the subsequent
swelling, which is oftentimes produced by the fracture, as has been
already mentioned (7).
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