6. If to these indications we compare Desault’s apparatus for a rupture of the tendo Achillis, as described in the preceding memoir, we will readily perceive 1st, that it perfectly fulfils that indication which relates to the anterior fragment; 2dly, that that one which relates to the posterior fragment will be equally well fulfilled by the half flexed state of the leg, by the compression made on the muscles, and by a thick compress, not very broad, laid transversely above the fragment, secured by the long roller, and afterwards by a circular bandage, which must form here, as in the case of a fractured rotula, a kind of figure of 8 around the fracture. This compress is the only modification of the apparatus requisite to accommodate it to the particular case now under consideration.
7. In applying the figure of 8 bandage here, as well as in the case of a fractured rotula, to prevent the ascent of the fragment, it is necessary to use the utmost care to free the integuments from wrinkles both above and below the fracture, lest by getting between the fragments, they might keep them asunder, and thus impede their reunion.
8. Desault used to relate in his lectures, the case of a woman whom he had formerly seen receiving a fracture of the os calcis, by falling from a great height. I cannot state the case fully, because I am not in possession of all the facts. The following one however drawn up during the first years of Desault’s practice in the Hotel-Dieu, will furnish an example of his mode of treatment.
Case. A man, likely to be arrested by some one who pursued him, leapt from a window nearly twelve feet high. In lighting, his feet struck on a beam which lay in his way, in such a manner, that the fore part of them only was supported. He made an effort to recover his equilibrium, but as the line of gravity of his body had nothing to rest on, he fell backwards, rose in order to make his escape, but fell a second time unable to rise again.
When assistance came to him, he complained of a severe pain in his heel, and said, that on falling, he had heard a considerable report. He was taken up, and assisted in walking to the Hotel-Dieu, where he did not arrive without pain, being able to bear only on the point of the diseased foot, and suffering greatly if he attempted to put his heel to the ground.
From the signs mentioned (3), Desault perceiving that there existed a fracture of the os calcis, made arrangements for reducing it. This he did by extending the foot on the leg, and drawing down the exterior fragment from the elevation to which muscular contraction had raised it, so as to bring it into perfect contact with the body of the bone. He then applied the common apparatus for a rupture of the tendo Achillis, with the modification already pointed out (6).
In the evening venesection was prescribed: the patient experienced sharp pains at the place of the fracture; a slight swelling occurred at the ends of the toes; an anodyne was prescribed. Next day, evidently better: venesection again. Fourth day, the patient is allowed to return to his usual regimen. Eighth day, apparatus removed for the first time; fragments in contact. Fifteenth day, a second application of the bandage. Nineteenth day, bilious symptoms. Twenty-first, an emetic given in solution. Thirty-second day, further evacuations: apparatus renewed. Forty-seventh day, consolidation complete. A stiffness remained in the part for some time, but this was gradually removed by exercise.