A Treatise on Fractures, Luxations, and Other Affections of the Bones

by P.-J. Desault

97. What shall we say respecting the idea of the synovia wetting the divided surfaces, and by that means preventing their reunion? The history of fractures communicating with joints, better known at the present day, answers this objection, which is indeed nothing but the offspring of mere hypothesis. To these considerations, which are dictated by reason, and to which many more might be added, let us unite the proofs derived from experience, and we will find numerous examples of cures actually performed, particularly in latter times; the truth of this is attested by many cases collected by Desault, both at the hospital of Charity and the Hotel-Dieu. Bruninghausen and Siebold, have had equal success. Many analogous facts have been presented to the Academy of Surgery. In the cabinet of the School of Health, are deposited some preparations obtained from the cabinet of Desault, calculated to remove all difficulties and doubts from this subject.

98. We must acknowledge, however, that in persons advanced in years, the cure is always difficult, often very tedious, and sometimes impracticable, however carefully the treatment may be conducted. But this is only a necessary consequence of the laws of ossification, which, constantly accumulating in the bones too great a quantity of calcareous matter, seems to deprive them by degrees both of life and all its properties. Yet Lesne laid before the academy a case of reunion obtained in a subject at the advanced age of eighty-four.

99. The observations of some modern practitioners seem to prove, that the reunion here is not produced by a substance similar to common callus, but by a kind of ligamento-cartilaginous tissue, in like manner as in the rotula, and the olecranon. But why need we inquire after the means employed by nature? those of art must be the same. It will be always necessary to favour the reunion, by bringing the fragments into contact, and maintaining them so. Without this contact, either a cure will never be obtained, or the substance destined to effect a reunion, becoming deformed and too bulky, will impede motion.

100. Lameness has been long considered as the inevitable consequence of fractures of the neck of the os femoris. Ludwig, professor of surgery at Leipsick, has particularly advocated this opinion, which is supported by Sabatier, and Louis, who considered the total destruction of the neck of the bone, as the cause of the lameness. But few such examples are to be found on record. Ruisk has given an engraving of one. Lameness when it does take place, depends, as it does in oblique fractures of the body of the bone, on the overlapping of the fragments, to which no opposition has been made; so that the insufficiency of our means, and not the nature of the disease, gives rise to this accident, which Desault seldom experienced in his practice.

101. From what has been said, it appears, that, in all respects, authors have given a much more unfavourable prognosis in fractures of the neck of the os femoris than facts and the nature of the affection will justify, that the progress of these fractures is the same with that of all others, and that, when treated with equal skill, there is no reason why their termination should not be equally favourable.

§ XVI.

OF THE REDUCTION AND THE MEANS OF MAINTAINING IT.

102. Reduction, in this case, is attended in general with but little difficulty. The patient, lying on his back, is held under the arm-pits, and by the upper part of the pelvis, by assistants who make counter-extension in this way, without being obliged to pass, as recommended by the Academy of Surgery, a strap under the affected thigh (30). Another assistant makes extension, according to the method formerly described (29), drawing the point of the fragment very gradually in the direction opposite to that which it has taken in becoming displaced, and making the thigh at the same time rotate a little on its own axis. This gentle rotation renders success more certain.

103. If things be properly arranged, a slight effort is sufficient to bring the separated fragments into contact and to restore to the limb its natural form; for, as I have already observed (86), a facility of reduction is even one of the characters of this fracture. But it is very difficult for art to maintain permanently what she easily effects at the time of reduction, and on this account, our curative processes are oftentimes insufficient.