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

by P.-J. Desault

The patient was carried home, where a surgeon who was ignorant of his profession being called, did nothing but apply a cataplasm to the foot. In the evening the parts began to swell, and were extremely painful; fever supervened, accompanied with great restlessness. Third day, to a rapid increase of all the symptoms was added a delirium; blood-letting from the jugular vein was prescribed to no purpose; things continued to grow worse till the sixth day, when the patient was brought to the Hotel-Dieu, in extreme danger.

The following was then the state of the parts. A considerable swelling around the joint; a projection of the malleolus internus, with a depression underneath it; a preternatural direction of the tibia before, and of the os calcis, behind; a depression near the lower end of the fibula; a crepitation readily perceived, on moving the fragments; a large tumour on the outside of the foot: with a depression and mobility of the malleolus externus.

The luxation was immediately reduced. Extension made on the foot and leg brought the parts into their proper situations, where they were retained by means of the bandage for fractures of the leg, and four compresses well secured by the bandage. One of these compresses, being placed on the malleolus internus, another on the outside of the foot, a third on the anterior and lower part of the tibia, and the fourth under the os calcis, prevented these different parts from being again displaced.

As soon as the apparatus was applied, the pupils remarked with astonishment, that the restlessness of the patient ceased, that his pains were relieved, and his delirium disappeared; he expressed his surprise at the state from which he had just recovered, and was now able to give an accurate account of his fall. He was scarcely put to bed, when he fell into a tranquil sleep, which lasted three hours. For six days previously he had not slept a moment.

In the evening, the patient was free from pain, and perfectly tranquil. Diluting drinks were prescribed, with twenty-five drops of Hoffman’s anodyne liquor: the apparatus was wet from time to time with vegeto-mineral water: the patient slept well throughout the night.

Next day, the apparatus renewed: the parts perfectly in place: swelling diminished; same means continued. Sixth day, the anodyne discontinued. Tenth day, swelling still less; echymosis gone; a yellow colour in the skin, an evidence that resolution is going forward. Twentieth day, swelling gone.

Thirtieth day, the fracture of the fibula healed; that bone slightly separated from the tibia: the circular roller drawn tighter; and a thick compress placed on the external malleolus, to bring it to its proper place. Forty-fifth day, the apparatus for a fractured leg removed, and a simple roller substituted in its place: the motions of the foot painful and contracted; a small gangrenous spot appeared on the heel. Fifty-fifth day, the ulcer which proceeded from this spot healed: motions of the part more free and extensive. Sixty-first day, the patient able to walk without assistance, though not without pain.

5. It is difficult to find an instance where the advantages of reduction have been more remarkable than in the preceding one. The patient had passed six days in pain, extreme agitation, and uninterrupted delirium: the foot was reduced, and these unfavourable appearances instantly vanished, and were succeeded by a state of tranquillity. Alarmed by such a state of things, the ancients would doubtless have proceeded to amputation. Let us examine into the motives which led Desault to an opposite line of practice, and then inquire into the cause of the success with which that practice was crowned.