SECT. LXXXIX.—ON FRACTURES AND THEIR DIFFERENCES.
Having described the surgical operations on the fleshy parts, we have next to give an account of those which relate to the bones, I mean the treatment of fractures and dislocations; for these also fall under the department of surgery. And first, of fractures, beginning with fractures of the bones of the head, because they hold an intermediate place between the operations on the fleshy parts and the bones, and because the cranium overtops all the other parts. In general terms, then, a fracture is a division of a bone, or rupture, or excision of it, produced by external violence. The differences of fractures are many. A bone, then, is said to be fractured raphanatim, scandulatim, in unguem, polentatim, and per defractionem. A fracture raphanatim is a transverse one through the thickness of the bone, and is called also cucumeratim and caulatim, because cucumbers and cabbages break in this way. Scandulatim is a longitudinal fracture of a bone. In unguem is a fracture at one part straight, and at its extremity lunated, and it is also called arundatim. Polentatim is a fracture of a bone into small pieces; and it is also called nucatim by some: Defractio or præcisio is when part of a bone is taken away with tearing of the skin, so that part is removed and is wanting. These are the differences of fractures.
Commentary. The following is a list of the ancient authors who have treated of fractures and dislocations: Hippocrates (de Fracturis; de Articulis; de Vulner. Capit.; Officina Medici); Galen (Comment. in eosdem, Meth. Med. vi.); Celsus (viii); Oribasius (de Machinamentis, &c.); Nicetæ Collectio ex Chirurg. Græc.; Apollonius Citiensis (Scholia in Hippocrat. ed. Dietz); Avicenna (iv, 5, 23); Rhases (ad Mansor. vii, 26; Divis i, 140; Cont. xxix); Averrhoes (Collig. vii, 36); Avenzoar (ii, 6, 1); Haly Abbas (Pract. ix, ad finem.)
Hippocrates does not make use of the technical terms explained by our author in this section, and Galen hints that he thinks his Master did better in confining himself to words generally understood. Galen defines only a few of these terms. He calls that kind of fracture in which the end of a bone at an articulation is entirely taken away, âbruptio (ἄπαγμα.) A transverse fracture with a complete separation of the broken portions is called a fracture caulatim (καυληδὸν.) A longitudinal division not attended with an entire separation of the parts is called scandulatim (σχιδακηδὸν.) He thinks the later writers on the subject who had introduced the use of such terms as raphanatim (ῥαφανηδὸν) and polentatim (ἀλφιτηδὸν) had refined too much.
All the terms mentioned by our author occur in a fragment of Soranus, preserved in the collection of Nicetas. They are also treated of very elaborately in the fragments of Heliodorus, contained in the same collection.
Celsus, who was studious of perspicuity and elegance, avoids all technical terms as much as possible. He thus defines the varieties of fractures. A bone, he says, may be split longitudinally like a piece of wood, or it may be broken transversely or obliquely, and its ends may be blunt or sharp, which last variety is the worst of all, as they cannot be easily made to unite with the other parts, and are apt to wound the muscles and nerves. Sometimes the bone is broken into fragments, and in certain bones a fragment is occasionally separated entirely from the broken bone.
The Arabians, especially Avicenna, Haly Abbas, and Albucasis, adopt the terms used by our author. Albucasis remarks, that the fracture of a bone is recognised by the derangement of the broken pieces, by their projection, and the crepitus produced upon pressure. He says, however, that there may be a fissure without derangement or crepitus.