Manual of Surgery Volume Second: Extremities—Head—Neck. Sixth Edition.Thomson, Alexis
Science
Manual of Surgery Volume Second: Extremities—Head—Neck. Sixth Edition.
Thomson, Alexis
Surgery
_Treatment._--It is probably true that the best functional results are
most speedily obtained by operative measures. The laceration of the
aponeurosis of the quadriceps, the tilting of the fragments, and the
interposition of the torn periosteum between them, can in no other way
be rectified with certainty. The operation, however, should only be
undertaken by those who are familiar with wound technique, and who
have the means at their disposal for carrying it out. Operative
treatment is specially indicated in young subjects who lead an active
life, and in labouring men, particularly those who follow dangerous
employments necessitating stability of the knee.
As soon as the wound is healed,--in a week or ten days,--massage and
movement of the limb are commenced, and the patient is encouraged to
move his limb in bed. At the end of another week he may be allowed up
with sticks or crutches.
_Non-operative Treatment._--In the majority of cases occurring in
patients who do not follow a laborious occupation or otherwise lead an
active life, a satisfactory result can be obtained without having
recourse to operation. We have reason to be satisfied with the
following method: the patient is kept in bed for a few days, the
injured region being supported on a pillow and massaged daily, and the
patella moved from side to side as a whole to prevent adhesion to the
femur. About the fourth day he is allowed to get about with crutches.
As osseous union of the fragments is not essential to a good
functional result, and as fibrous union does not necessarily entail
any material interference with the usefulness of the limb, no attempt
need be made to approximate the fragments, but every effort must be
made to maintain the function of the quadriceps muscle and the
mobility of the joint.
If it is desired to bring the fragments into contact and to secure
osseous union, the limb should be placed upon an inclined plane to
relax the quadriceps muscle, and means taken to arrest effusion and to
diminish the swelling by systematic massage and a supporting bandage.
When, in the course of a few days, this has been accomplished, the
attempt is made to approximate the fragments, by fixing a large
horseshoe-shaped piece of adhesive plaster to the front of the thigh,
embracing the proximal fragment. Extension is made upon this by means
of rubber tubing, which is fixed to the foot-piece of the splint. The
bandage which binds the limb to the splint should make upward pressure
on the distal fragment, or this may be done by a special piece of
adhesive plaster with elastic tubing pulling in an upward direction.
The retentive apparatus is kept on for about three weeks, and a rigid,
but easily removable, apparatus is thereafter applied, and the patient
allowed up on crutches, the limb being massaged and exercised daily to
improve the tone of the muscles.
Public-domain text, read in full here on John Shaqi.
Reviews
Reviews
No reviews yet
Be the first to share your thoughts on this work.
Elsewhere in the archive
Join the Discussion
Join the discussion
Sign in to leave a comment or review.
Sign InorCreate an account