ARTICLE II.
An account of Dr. Physick’s improvement of Desault’s apparatus for making permanent extension in oblique fractures of the os femoris.
Dr. Physick having observed that in the application of Desault’s apparatus, the patient was sometimes injured by the pressure of the strap or roller g g ([plate 2]) which passes under the tuberosity of the ischium for the purpose of making counter-extension, devised the following method of remedying this inconvenience, in which he succeeded to his wishes.
He directed the upper end of the long external splint to be formed like the head of a crutch, and the splint itself to be lengthened so as to reach and bear against the axilla of the affected side, which must be well defended from pressure by a bolster of flannel or some other soft material. By this expedient the Dr. evidently formed two points of counter-extension, instead of one, as is the case in the apparatus of Desault. Between these two points, namely, the axilla and the perineum, the same quantity and force of pressure is, by Dr. Physick’s improvement, divided, which, in the original apparatus of Desault, is borne by the perineum alone. The risque of excoriation and injury to the patient, then, in the former case, is to that which he runs in the latter, only as one to two, or nearly so. As it is no less the duty of the surgeon to prevent suffering than it is to remove deformity or to save life, Dr. Physick has certainly in this respect made an important step in the advancement of his profession.
But there is still another advantage derived from the lengthening of the external splint. In the original apparatus of Desault, the strap gg intended for counter-extension, by passing no higher up than the spine of the ilium, runs too much across, and therefore acts too much on, the upper part of the thigh. By this it not only irritates the muscles of the part, and induces them to contract, but also tends to draw the upper fragment of the os femoris a little outward, and thus to render the thigh in some measure deformed. But, in the improvement of Dr. Physick, the strap gg is secured in a mortise cut in the external splint, about midway between the spine of the ilium and the axilla. This strap, by being thus carried higher up on the body, does not run across the thigh at all. It consequently presses on and irritates the muscles much less, acts more in the direction of the os femoris, and has no tendency to draw the superior fragment outward.
Hence this improvement not only diminishes the patient’s sufferings, but gives him, perhaps, the best possible chance of having his limb preserved free from deformity.
Another improvement made on the lower end of the external splint by Dr. James Hutchinson deserves also to be mentioned. It was found that in the original apparatus of Desault, the strap or roller L ([plate 2]) used for the purpose of extension, had a tendency to draw the foot too much outward. This fault Dr. Hutchinson very ingeniously remedied, by attaching to the lower part of the external splint, a little above the mortise, a small block extending inwardly, at a right angle with the splint, so far as to be on a line with the middle of the sole of the foot. Over the end of this block, in which a notch is cut to receive them, the ends of the strap L are carried, previously to their being secured to the external splint. By means of this expedient extension is made precisely in the direction of the limb, and the inconvenience of drawing the foot outward is completely obviated.
Thus improved by Drs. Physick and Hutchinson, the apparatus of Desault for oblique fractures of the os femoris, leaves, perhaps, scarcely a remaining desideratum on the subject.