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

by P.-J. Desault

4. The broad and strong splints which form a part of this apparatus, have the following advantages over those previously used both by the ancients and the moderns; 1st, they come in contact with and bear on a larger extent of the surface of the limb; 2dly, they consequently maintain the fragments in apposition with greater firmness and effect; 3dly, they prevent the rotation of the foot outwards, an accident which very frequently occurs when the fracture is complete, that is, when both bones are broken; 4thly, they remain constantly in their place, without slipping either forward or backward, an inconvenience necessarily attendant on the other splints, which, from their roundish form, touch the limb in only one point or line.

5. To sustain the foot, Petit recommends a piece of a board to be applied immediately to its sole, and supported by two bits of tape fastened to the splints. This practice is adopted to some extent even at present: but a simple roller, applied in the manner already mentioned, is sufficient for the purpose; the tendency of the foot to turn outwards is never so strong as not to be effectually resisted by this expedient: besides, should the piece of board be placed ever so little too vertically, it retains the foot in a state of inconvenient and painful flexion.

6. The situation of the leg, gently flexed by means of a thick cushion or pillow placed between it and the mattress, is, in all respects to be preferred to the method of Pott, which is exclusively adopted by Bell. What, indeed, can be the object of this latter method? To relax, say they, the muscles, that tend to make the lower fragment overlap the upper one. But is it not evident, that most of these muscles, not being attached to the os femoris at all, cannot be influenced by this position? To obtain the relaxation of the posterior muscles, it is necessary to flex the foot; but, in such a case, the anterior muscles are necessarily in a state of tension: this completely counter-balances the relaxation of the others, and, therefore, there is nothing whatever gained. It is certainly much best to allow the leg to be in a state of moderate flexion, such as we assume when asleep, and which appears to be the most natural.

7. The apparatus just described, produces on the fragments a twofold action: 1st, by a kind of side walls formed by the splints, it prevents their displacement laterally, and from this circumstance alone, is fully sufficient for the retention of transverse fractures: 2dly, the pressure of the rollers, splints, and bolsters, if these be applied with sufficient tightness, prevents the lower fragment from mounting on the upper one, and thus preserves the natural length of the limb. Hence its advantages in oblique fractures; and, as the powers of displacement are weaker here than in the thigh, this apparatus, is in general, sufficient to counteract them.

8. It is true that cases do sometimes though rarely occur, where, in consequence, of being irritated by splinters, or the points of the fractured bone, or acted on by some other causes which make them contract, the muscles overcome the resistance of the apparatus, and make the fragments overlap. Under such circumstances, permanent extension affords here the same advantages as in fractures of the thigh.

9. Most authors, to obtain the desired end in such cases, recommend means calculated to act on the thigh. Thus, Manne proposes the use of his glaussocome. Desault, under such circumstances, effected his purpose by the apparatus described in the following case.

§ II.

10. Case II. Pierre Bejol, aged thirty-seven, of a strong and vigorous constitution, fell, as he was carrying a heavy load, over a beam which lay in his way. His leg was fractured towards its lower part; he was lifted up and carried home, where a surgeon, by making unskilful efforts at reduction, gave him extreme pain.

A roller and a kind of round splint applied to each side of the limb, forming the whole of the apparatus, and not being sufficient to retain the fragments, soon allowed them to overlap each other nearly two inches. The pains continue; a considerable swelling appears around the fracture; the patient is greatly agitated; he is brought to the Hotel-Dieu, where, from the deformity of the limb, Desault was satisfied, at first sight, of the existence of a fracture; on a more attentive examination, it was discovered to be complete and very oblique.