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
On the thirty-seventh day, the patient was discharged perfectly
cured, and free from every vestige of his disease, except a trifling
stiffness, which was doubtless soon removed by the motions of the joint.
17. When wounds, splinters, or severe contusions, render these kinds
of fractures more complicated, an inflammation occurring on the
articular surfaces, may cause them to unite together, and by that
means give rise to an anchylosis. But this accident, inevitable in
such a case, according to writers, does not always occur, provided
nature be assisted, by a judicious mode of treatment, in her attempt
to reunite the broken bone. Desault has established this truth, in
many instances. Here, as in other joints, he has oftentimes obtained
a complete cure, without the loss of motion, although the part had
sustained the greatest violence. Incisions, easily made, the extraction
of splinters, a frequent renewal of dressings, a most vigilant care to
prevent all jarring of the limb, and consequently all derangement of
the contact of the fragments, an assemblage or combination of those
minute attentions, which art cannot teach, which genius suggests, and
which characterize the true surgeon; a precaution (not to be dispensed
with) to make the limb perform motions, gentle at first, but gradually
increased afterwards, when the adhesion of the parts has acquired
sufficient solidity to admit of it; such are, in general, the steps and
circumstances constituting the bases of that treatment, requisite in
these complicated fractures, which, like all others, appear, in each
case, to assume a new aspect, and to present different indications.
CASE II. A person, carrying a heavy burden, fell with his elbow on
a sharp corner of a bar of iron. The external condyl was broken,
being separated from the body of the bone, by an oblique division
running into the joint. Anteriorly, a large contusion; posteriorly,
a transverse wound; on the outside, the end of the condyl projecting
through the soft parts, which it had lacerated: such were the
complications of a fracture, for which the patient was admitted into
the Hotel-Dieu, on the seventh day of January, 1794.
On examining the state of the parts, Desault discovered, in the
transverse wound, two splinters which when extracted, gave vent to an
effusion of blood. He reduced, instead of cutting it off, as authors
have advised, the end of the separated condyl, applied a bandage of
strips,[13] and, to prevent accidents, ordered a strict diet, copious
blood-letting, and diluting drinks.
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