Notwithstanding these precautions, the tumefaction and redness were increased on the following day. The bandage was applied anew, and wet from time to time with vegeto-mineral water.
On the following days, pain less severe, the bandage kept constantly wet with the same fluid.
Eighth day, the swelling almost gone; the apparatus, being loosened, was again reapplied.
Fifteenth day, the fragments, being examined, were found in regular contact, and already united by a substance of considerable firmness; the strictness of regimen gradually relaxed; solid food taken in small quantity.
Nothing new till the twenty-second day, when the splints were laid aside, having become useless, in consequence of the rapid progress of reunion: from this time till the completion of the cure, nothing was used but the simple roller.
On the twenty-fourth day, gentle flexion and extension of the arm and fore-arm were for a short time performed; these movements were attended with acute pain, notwithstanding which, the fortitude of the patient enabled him to persevere in them.
Thirtieth day, no pain accompanies the movements of the arm: the range of these movements visibly increased; the roller laid aside; from this time the range of motion increases rapidly.
On the thirty-seventh day, the patient was discharged perfectly cured, and free from every vestige of his disease, except a trifling stiffness, which was doubtless soon removed by the motions of the joint.
17. When wounds, splinters, or severe contusions, render these kinds of fractures more complicated, an inflammation occurring on the articular surfaces, may cause them to unite together, and by that means give rise to an anchylosis. But this accident, inevitable in such a case, according to writers, does not always occur, provided nature be assisted, by a judicious mode of treatment, in her attempt to reunite the broken bone. Desault has established this truth, in many instances. Here, as in other joints, he has oftentimes obtained a complete cure, without the loss of motion, although the part had sustained the greatest violence. Incisions, easily made, the extraction of splinters, a frequent renewal of dressings, a most vigilant care to prevent all jarring of the limb, and consequently all derangement of the contact of the fragments, an assemblage or combination of those minute attentions, which art cannot teach, which genius suggests, and which characterize the true surgeon; a precaution (not to be dispensed with) to make the limb perform motions, gentle at first, but gradually increased afterwards, when the adhesion of the parts has acquired sufficient solidity to admit of it; such are, in general, the steps and circumstances constituting the bases of that treatment, requisite in these complicated fractures, which, like all others, appear, in each case, to assume a new aspect, and to present different indications.
Case II. A person, carrying a heavy burden, fell with his elbow on a sharp corner of a bar of iron. The external condyl was broken, being separated from the body of the bone, by an oblique division running into the joint. Anteriorly, a large contusion; posteriorly, a transverse wound; on the outside, the end of the condyl projecting through the soft parts, which it had lacerated: such were the complications of a fracture, for which the patient was admitted into the Hotel-Dieu, on the seventh day of January, 1794.