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
6. As the whole apparatus in this case consists in a passive resistance
to the active powers employed in producing a displacement, it follows
from what has been said (4), that the bandage intended to prevent
this displacement, and by that means to guard against the accidents
specified above (5), ought, either effectually to bring back to its
natural situation, the condyle which is drawn forward, or pull in this
last direction (that is, forward) the body of the bone which is still
retained in its usual position, in order that it may thus be brought
into contact with the condyle.
The first of these measures is impracticable, in consequence of the
situation of the condyles, which are too deeply enveloped by the
surrounding parts, and offer a hold too small to be acted on. The
second, therefore, remains to be adopted, and is the more easily
executed, in as much as the angle of the jaw, from its projecting and
being but slightly covered by the integuments, may without difficulty
be directed from behind forward by a proper force.
7. The fingers of the surgeon temporarily supply this force, at the
time of reduction; but it is necessary that it should be permanently
kept up by means of the apparatus. This end is attained, in the
following manner:
Place behind the angle of the jaw, which must be first pushed forward,
thick compresses, to fill up the hollow under the ear, and form an
eminence higher than the surface of the surrounding parts; pass over
these compresses, in an oblique manner, the bandage commonly used in
lateral fractures of the bone, the application of which must in this
case commence on the sound side.
These compresses, being more projecting than the surrounding surface,
will necessarily sustain a greater pressure, because the compression
made by a bandage is in proportion to the projection of the part on
which it is applied. Hence, being firmly supported, they will retain
the body of the bone in a line with the displaced condyle (4).
8. In addition to this mode of applying the bandage, it is necessary
that the fractured bone should be kept in a state of perfect rest. The
internal pterygoid and masseter muscles, tending by their contractile
efforts to draw the angle of the jaw backwards, sometimes overcome the
resistance of the apparatus, and, by producing a second displacement,
give rise to the accidents formerly mentioned (5).
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