Manual of Surgery Volume Second: Extremities—Head—Neck. Sixth Edition.

VOLUME SECOND EXTREMITIES—HEAD—NECK
SIXTH EDITION REVISED AND ENLARGED WITH 288 ILLUSTRATIONS
LONDON HENRY FROWDE and HODDER & STOUGHTON THE LANCET BUILDING 1 & 2 BEDFORD STREET, STRAND, W.C. 2
Printed in Great Britain by Morrison and Gibb Ltd., Edinburgh

The injuries to which a bone is liable are Contusions, Open Wounds, and Fractures.
Contusions of Bone are almost of necessity associated with a similar injury of the overlying soft parts. The mildest degree consists in a bruising of the periosteum, which is raised from the bone by an effusion of blood, constituting a hæmatoma of the periosteum . This may be absorbed, or it may give place to a persistent thickening of the bone— traumatic node .
Open Wounds of Bone of the incised and contused varieties are usually produced by sabres, axes, butcher's knives, scythes, or circular saws. Punctured wounds are caused by bayonets, arrows, or other pointed instruments. They are all equivalent to compound, incomplete fractures.
A fracture may be defined as a sudden solution in the continuity of a bone.
A pathological fracture has as its primary cause some diseased state of the bone, which permits of its giving way on the application of a force which would be insufficient to break a healthy bone. It cannot be too strongly emphasised that when a bone is found to have been broken by a slight degree of violence, the presence of some pathological condition should be suspected, and a careful examination made with the X-rays and by other means, before arriving at a conclusion as to the cause of the fracture. Many cases are on record in which such an accident has first drawn attention to the presence of a new-growth, or other serious lesion in the bone. The following conditions, which are more fully described with diseases of bone, may be mentioned as the causes of pathological fractures.
Atrophy of bone may proceed to such an extent in old people, or in those who for long periods have been bed-ridden, that slight violence suffices to determine a fracture. This most frequently occurs in the neck of the femur in old women, the mere catching of the foot in the bedclothes while the patient is turning in bed being sometimes sufficient to cause the bone to give way. Atrophy from the pressure of an aneurysm or of a simple tumour may erode the whole thickness of a bone, or may thin it out to such an extent that slight force is sufficient to break it. In general paralysis, and in the advanced stages of locomotor ataxia and other chronic diseases of the nervous system, an atrophy of all the bones sometimes takes place, and may proceed so far that multiple fractures are induced by comparatively slight causes. They occur most frequently in the ribs or long bones of the limbs, are not attended with pain, and usually unite satisfactorily, although with an excessive amount of callus. Attendants and nurses, especially in asylums, must be warned against using force in handling such patients, as otherwise they may be unfairly blamed for causing these fractures.