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

by P.-J. Desault

One assistant is directed to fix and secure the trunk in a proper manner. This he does by pulling at the arm of the sound side, taking hold of it near to the hand, and extending it in a direction perpendicular to the axis of the body. This mode of counter-extension is preferable to that commonly employed, which consists in applying the hands to the upper part of the patient’s shoulder. Indeed, on the one hand, the power being farther removed from the resisting force, need not be so great. And, on the other, the body being entirely unencumbered, renders it easy for the surgeon to apply the roller without discontinuing, or in any way disturbing, the extension.

Another assistant makes extension on the fore-arm, which serves him as a lever, where, one hand being placed behind or on the back of the wrist, forms the point of support, (or fulcrum), while the other applied to the anterior and middle part of the fore arm, on which it makes pressure from above downward, represents the power; the fragments to be brought into contact constitute the resistance.

The relaxation of the muscles produced by this semi-flexion of the fore-arm, and the slight separation of the arm from the trunk, greatly favour this mode of extension; a mode recommended by the ancients, adhered to by the English, and which possesses the advantage of leaving uncovered all that portion of the limb on which the apparatus is to be applied, and by that means of allowing the hands of the assistant to keep the same position during the whole time of the application.

A small degree of force, judiciously directed according as the displacement is inward or outward, is sufficient to effect the reduction, which even takes place of its own accord, under this process. If the surgeon lays his hands on the place of fracture, it is rather to examine the state of the fragments, than to assist in bringing them into apposition.

§ VI.

OF THE MEANS OF MAINTAINING THE REDUCTION.

16. All kinds of apparatus for fractures, being nothing but resistances opposed by art, to the powers which produce displacement, it follows, that they should all act in directions precisely opposed to the directions of those powers. But, we have seen (7), that, in the present case, these powers are, 1st, the action of external bodies, favoured by the extreme mobility of the arm and shoulder; 2dly, the action of the latissimus dorsi, the pectoralis major, and the teres major, which carry the inferior fragment inward, or, what is more common, of the deltoid muscle, which draws it outward; 3dly, the contractions of the muscles of the arm, which have a slight tendency to draw the same fragment upwards.

17. Therefore, 1st, to render the arm and shoulder immoveable; 2dly, to carry the upper end of the lower fragment outward or inward, according to the direction in which it is displaced; and, 3dly, to draw this fragment downward, are the three indications that ought to be fulfilled by every bandage intended for a fracture of the neck of the humerus. The last merits less attention than the other two, because, as already observed, the weight of the limb alone is nearly sufficient to answer it.

18. Let us inquire, whether or not the kinds of apparatus, hitherto employed, have been adequate to the fulfilment of these indications.