From this view and explanation of the apparatus Fig. 1, I presume its construction, application, and mode of operation will be very easily understood. It is unnecessary therefore to add, that the extension and counter-extension made on the limb, will be directly proportioned to the degree of force with which the ends a a of the handkerchief B are drawn over the cross-piece F. As action and reaction, in this case, must, as in all others, be equal, the splints G G will be pushed upward by the ends of the handkerchief B with precisely the same force that is applied on these ends to draw the foot and lower fragments downward. Hence the counter-extension made above on the roller A will be exactly equal to the extension made below by the handkerchief B.
I ought to have observed, that it is necessary to defend the soft parts, both above and below, from the pressure of the extending and counter-extending straps, by means of soft compresses applied next to the skin. This is particularly necessary on the instep C where the ends of the handkerchief B cross each other. It requires some attention on the part of the surgeon to prevent this spot from being excoriated, especially if it be found necessary to make a forcible extension.
If the fracture be simple, a bandage of strips previously applied round the limb from the ancle to the knee is highly useful. It secures the fragments more effectually from lateral displacement, and prevents the swelling of the leg. A simple roller applied with a moderate degree of tightness round the foot, is also of service in preventing a swelling in that part, as well as in removing it if it has already occurred.
This apparatus is still more strikingly useful in compound fractures, on account of the facility with which it enables the surgeon to apply the necessary dressings. These can be renewed as often as may be requisite, without giving the patient the least pain, without discontinuing extension, or in any measure whatever deranging the fragments. The surgeon can also, in all cases, discover by a single glance of his eye, whether or not the fragments are in proper apposition. It is right to secure the whole apparatus by three bits of tape passed round it, similar to those tied round the leg in the apparatus for fractures of the thigh, as represented in [plate 2].
I shall only add, that the surgeon must employ such bolsters and compresses as he may find necessary to support the limb, and protect it from undue pressure, and that he must be vigilant to prevent, by frequent examinations, the extending and counter-extending straps from becoming relaxed.
For a few further remarks on the subject of this apparatus, the reader is referred to a paper published by Dr. Hutchinson, in the second number of the Philadelphia Medical Museum.
FINIS.
Return to [transcriber’s notes]
Inconsistencies:
armpit/arm-pit
condyl/condyle
coracoid/corocoid
coronoid/coronoide
expence/expense
fixt/fixed
forearm/fore-arm/fore arm
inconveniencies/inconveniences
plane/plain
Scultel/Scultet
teres-major/teres major