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

by P.-J. Desault

Neither pain nor swelling supervened, and by the fourth day, the reunion was complete. In a short time motion was performed with as much ease as before the occurrence of the complaint. In the mean while, a degree of uneasiness remained in the joint; but barely perceptible at first, this uneasiness continued to increase; in about four months, symptoms of the existence of another foreign body made their appearance.

M. Vielle being now a distance from Desault, put himself under the care of his brother, who extracted a second body, in the manner already described, except that the incision was made at two strokes.

Dressing the same as in the preceding case, with this additional precaution, that the thigh and leg were covered by a roller, for the purpose of moderating the action of the muscles.

No fever, no pain; the reunion completed on the eighth day, except a small point in the centre of the wound, which suppurated slightly till the fourteenth. There was now neither difficulty in walking, nor the least sensation of pain. Since that time, M. Vielle has enjoyed the entire use of his limb.

OBSERVATIONS AND REFLECTIONS ON FORMS OF APPARATUS FOR FRACTURES OF THE LEG.

§ I.

1. Case I. (Reported by Levacher). Catharine Belet, aged fifty-five, of a strong and vigorous constitution, fractured her leg in the middle, by a false step in alighting from a carriage. Being carried home, in a careless manner, she was visited by a surgeon, who merely reducing the fracture, but applying nothing to retain the reduction, sent the patient to the Hotel-Dieu. She was conveyed on the same day to the amphitheatre, where Desault discovered the existence of the affection by the following signs.

Pain in the middle of the leg, less severe when the limb was at rest, more so when it was suddenly moved; the patient absolutely unable to support herself on it so as either to stand or walk since the accident; inequalities sensible to the touch on the anterior surface of the tibia; a shortening or contraction of about half an inch; a preternatural mobility at the place of the fracture; evident crepitation, produced by the rubbing of the fragments against each other, when moved in contrary directions: a change in the direction of the lower fragment, which was bent somewhat outwards. These signs, added to the circumstance of the fall, evidently announced a simple fracture of both bones. The reduction was effected in the following manner.

One assistant made counter-extension by grasping the lower part of the thigh with both his hands, the fingers being placed behind it, and his thumbs corresponding to its anterior surface. Another made extension, not as writers recommend, at the lower part of the leg, but on the foot itself, which was taken hold of in such a manner that the fingers met on its upper side, while the thumbs crossed each other on its sole. In this way a lever of the first kind was formed, the resistance to which was the fragment to be replaced, while its centre of motion was in the joint.