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

by P.-J. Desault

A reduction was immediately effected by means of extension and counter-extension, and was announced when it took place by a report distinctly heard. It was then retained by a bandage, calculated to answer a twofold purpose; 1st, to approximate, and keep together, the two bones of the leg: 2dly, to secure the contact and immobility of the bones of the foot.

Blood-letting was prescribed: an anodyne mixture administered; low diet; in the night severe pains were felt; next day, they were increased; on dressing the limb, nothing amiss discovered; all the parts in perfect contact: no vestige of separation between the tibia and the fibula: a new apparatus applied; and kept constantly moist. Third day, the patient better: fifth day, the fibula a little separated from the tibia: the circular bandage drawn tighter to reduce it to its place again. Tenth day, every thing in its natural state: no pains: swelling gone. Fifteenth day, a simple roller substituted in place of the bandage for a fracture of the leg. Nineteenth day, the patient began to walk, with the assistance of a stick: twenty-third day, walks easily: twenty-eighth day, is dismissed perfectly cured, and nearly free in all his motions.

13. The separation of the bones of the leg, at their lower end, does not constitute a very serious complication of luxations of the foot, although the contrary is asserted by several authors. Desault met with this accident several times in the course of his practice, but never saw it terminate otherwise than favourably. But here, as in all other cases, the most minute attention is necessary to ensure success, the want of which is more frequently owing to the negligence of the surgeon, than to the deficiencies of the art. The bandage employed after reduction ought to act principally from without inwards, and in a direction perpendicular to the axis of the lower part of the leg, in order to approximate the two bones. It will be of some service, in this respect, to place on each bone a compress, which, projecting more than the rest of the circumference of the limb, will be more compressed, and on that account, contribute to the end in view.

§ IV.

LUXATION OF THE FOOT, ACCOMPANIED BY A DISPLACEMENT OF THE ASTRAGULUS AT ITS ARTICULATION WITH THE OS SCAPHOIDE.

14. Petit never met with more than two instances of that displacement of the astragulus, now under consideration. His general prognosis on the subject is more favourable than that respecting other luxations of the foot, with which he never saw the present luxation of the astragulus complicated, as occurred in the following cases. Had such complex cases fallen under his notice, there can be little doubt, but he would have declared amputation to be the only recourse of art on the occasion.

But the experience of Desault demonstrates to us here, as well as in the preceding cases, the great extent to which we ought to carry our confidence in the powers of nature, when skilfully guided by the hand of art. The following case was communicated to me by Leveille.

Case IV. John Baptist Landrin, a postilion, aged thirty-six, was brought to the Hotel-Dieu, on the 19th of February, 1791.

On the morning of the same day, a horse on which he was mounted having fallen, his foot was caught under the belly of the animal. As soon as he was disencumbered of the vast weight, he endeavoured to rise, but in vain. The pains which he experienced in his foot were extreme. He was carried home, where some surgeons, having ascertained that his foot was luxated, but being unable to reduce it, sent him to the Hotel-Dieu.