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
#Mechanism.#--When the skull is broken by _direct_ violence, the
fracture takes place at the seat of impact, and its extent varies with
the nature of the impinging object and the degree of violence exerted.
If, for example, a pointed instrument, such as a bayonet, a foil, or a
spike, is forcibly driven against the skull, the weapon simply crashes
through the bone, disintegrating it at the point of entrance, and
cracking or splintering it for a variable, but limited, distance
beyond. On the other hand, when the head is struck by a "blunt"
object--for example, a batten falling from a height--the force is
applied over a wider area and the elastic skull bends before it. If
the limits of its elasticity are not exceeded, the bone recoils into
its normal position when the force ceases to act; but if the bone is
bent beyond the point from which it can recoil, a fracture takes
place--"_fracture by bending_." The bone gives way over a wide area,
the affected portion may be comminuted, and one or more of the
fragments may remain depressed below the level of the rest of
the skull. Cracks and fissures spread widely in different
directions--often (70 to 75 per cent.) extending into the base. In
almost all fractures of the vault the inner table splinters over a
wider area than the outer, partly because it is more brittle and is
not supported from within, but also because the diffusion of the force
as it passes inwards affects a wider area. If a bullet traverses the
cranial cavity the inner table is more widely shattered at the
aperture of entrance, and the outer table at the aperture of exit. Von
Bergmann reported thirty cases in which the inner table alone was
fractured by a blow on the head.
Fractures by _indirect_ violence--that is, fractures in which the bone
breaks at a point other than the seat of impact--are almost always due
to violence inflicted with a blunt object, and acting over a wide
area--such, for example, as when the head strikes the pavement. Much
discussion has taken place as to the method of their production. It
has been shown that when the skull is depressed at one point by a
force impinging on it, it bulges at another, so that its whole contour
is altered. But the elasticity of the bone varies at different parts
of the skull, owing to differences in thickness and in structure. If,
therefore, the part which is depressed--that is, the part directly
struck--happens to be less elastic than the part which bulges, it
gives way, and a fracture by "bending" results; but if the bulging
part is the less elastic, it bursts outwards--_fracture by_
"_bursting_." The term "fracture by _contre-coup_" has been
incorrectly applied to such fractures when the area of bulging happens
to be opposite to the seat of impact. _Contre-coup_, properly
so-called, is only possible in a perfectly spherical body, which, of
course, the skull is not.
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