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

by P.-J. Desault

MEMOIR XVII.

ON COMPLICATED LUXATIONS OF THE FOOT.

§ I.

1. Complicated luxations of the foot, like complicated fractures, show themselves under such a variety of forms, are accompanied by so many peculiar affections, and so many different circumstances are connected with them, that it would be difficult to lay down rules applicable to their treatment in all cases. On this subject, indeed, art is in possession of certain general principles, liable however to numerous exceptions and modifications. In the treatment of such cases, who can fix the limits between reduction, and amputation or extirpation? Who can point out, with precision, where the one ceases to be useful and becomes hazardous; while the others constitute the only resources of art? Experience and talents alone are capable of deciding on these points, and that only in the chambers of the sick. It is, therefore, less by precept than example that practitioners ought to be instructed here.

2. To furnish suitable examples on this head constitutes my only object in the present memoir, which will consist of the histories of a few cases, with such inferences and remarks as the occasion may seem most naturally to suggest. Here the practice of a great master, varying his means with the varying forms of disease, will serve as models to those who may meet with similar cases. Our experience is composed of the facts which we receive from reading, as well as of those derived from observation. Who would have a right to call himself a surgeon, if he had no other title to that name, but such as resulted exclusively from his own personal observation?

3. However difficult it may be, as already observed, to speak in general terms, on the present subject, we may yet assert with safety, that authors have greatly exaggerated the danger of complicated luxations of the foot. Terrified at the extent and unpromising appearance of the accidents, these writers have lost that confidence in the powers of nature which we never ought to abandon. They have taken up an opinion, that luxations of the foot, differing in their symptoms from other luxations, require also a different mode of treatment; that reduction, by perpetuating the accidents of the case, must prove fatal, and that amputation ought to be adopted as the only resource. Cases do certainly at times occur, where a doctrine different from this would be fatal in its effects: such are those terrible lacerations, where the foot is entirely separated from the leg, except some shreds of flesh with a few tendons among them that still retain it.

4. But, provided the blood-vessels have escaped, and any hope of circulation and life in the part still remain, the success of reduction should always be first tried; and the following examples will show, what ought to be expected from this practice, when accompanied by skilful treatment.

§ II.

LUXATION OF THE FOOT, COMPLICATED BY A FRACTURE OF THE FIBULA, TIBIA, &C.

Case I. (The following case was collected by Leveille.) Abraham Genty, aged forty-three, a dealer in wine, as he was running along the street, slipped, and made a false step on his left foot, which turned with its external edge under him, and its internal edge upwards. He fell, luxated his foot, and fractured the fibula.