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

by P.-J. Desault

Extension being directed at first in the course or line of the displacement, till the limb had attained its usual length, was then directed in such a way as to restore to the leg its natural form. By this, the fragments being brought into apposition, united exactly without the process of coaptation being employed.[34] The apparatus, usually employed by Desault in such cases, was applied to maintain the reduction: the different pieces of it had been previously arranged on a pillow in the following order: 1st, four strong pieces of tape placed at equal distances from each other; 2dly, a junk-cloth,[35] long enough to reach from the knee beyond the sole of the foot; 3dly, a bandage of strips, similar to that described for the thigh (page [246]), arranged in the usual mode; 4thly, two long compresses, the lower one of which being the longest was turned back on the other; three bolsters had also been prepared; these, being formed of several pieces of linen joined together, were about one inch and a half thick: the broadest of these was designed to be placed on the anterior part of the leg; the two other lateral ones, though narrower, were a little longer, in order that, by folding back on themselves, they might be accommodated to the inequalities of the limb; 6thly, lastly, there were also prepared two splints, an inch broad, three lines thick, and of the same length with the junk-cloth.

Every thing being ready, the assistants still keeping up extension raised the leg a little, while a pillow was slipped under it, to support it equally and uniformly throughout its whole length. The leg was placed on this pillow in such a way as to correspond exactly to the middle of the apparatus which was arranged in order on it, and was previously wet with vegeto-mineral water.

On the anterior part of the leg was then applied a long compress, extending from the knee to the upper part of the foot. Over this were lapped the other two compresses, which had been previously placed in order as part of the apparatus. These were then secured by the bandage of strips, the application of which was begun at the lower strip next to the foot, and continued successively upwards with the rest, making them cross each other at the anterior part of the leg.

On the sides were placed the bolsters which were doubled at the ancle to protect that part from the pressure it might otherwise sustain. The splints were then applied along the external surfaces of the bolsters, the edges of the junk-cloth having been previously folded round them, in order to render their pressure the more close and steady. Along the fore part of the leg was laid the largest of the bolsters, and the whole was then secured by the four pieces of tape tied on the external splint, with a degree of tightness sufficient to keep the fragments immoveable.

A compress wet with vegeto-mineral water covered the foot, and was secured by a roller, applied in such a manner, that its two ends, crossing on the back of the foot, were fastened laterally to the two splints.

The leg, being firmly fixed by this apparatus, and gently flexed by means of a pillow placed under it, was protected by hoops from the pressure of the bedcloaths. The fragments being now in complete apposition irritated the parts no longer, in consequence of which the pain ceased.

The patient being properly disposed in bed, remained tranquil and easy throughout the remainder of the day. Diluting drinks and light nourishment were prescribed.

Next day, no pain; patient composed; a slight swelling on the back of the foot; the apparatus wet anew with vegeto-mineral water. Fourth day, the bandages a little relaxed; the point of the foot turned somewhat outwards; a new application of the apparatus. Seventh day, bilious symptoms appear, loathing of food, nausea, and bitterness of the mouth. Eighth day, tongue furred, inclination to vomit; loss of appetite; a grain of tartar emetic given in solution; copious dejections; evidently better: next day, appetite returned, tongue clean. Tenth day, a third application of the apparatus, which had become too loose. Fifteenth day, fresh bilious symptoms; further evacuations; success the same. Twentieth day, consolidation evidently advancing; no deformity of the limb; fourth application of the apparatus. Thirty-second day, consolidation almost complete; the apparatus still kept on till the forty-second day, when the patient was discharged perfectly cured.

2. This case, which is in no respect different from those that most frequently occur in practice, presents us with a view of the mode of reduction, the means of retention, and the subsequent treatment, employed by Desault, in cases of the kind. The advantage of the bandage of strips, which allows the limb to be uncovered without being disturbed, is now generally acknowledged in fractures of the lower extremities. In the treatment of these, practitioners reject entirely, at present, the roller bandage, which was recommended by Petit, Heister, and all the authors who preceded them, and which, by producing a new displacement, at each time of reapplication, may entirely prevent the fragments from uniting. The bandage of Scultet, brought into use again by Desault, the form of which has been just described, is also preferable to the eighteen-tailed bandage, which some practitioners still employ.

3. The strips which compose the former bandage, being narrower than the tails of the latter, can be more neatly applied to the leg, as they more readily mould themselves to its inequalities; the compression made by them is, therefore, more exact, more uniform, and consequently less inconvenient. If one of the strips become soiled, it can be changed without deranging the bandage. (Respecting this point, see what was said on fractures of the thigh.) This bandage being less bulky than the eighteen-tailed one, is therefore less troublesome to the patient.