[62] [The bones, owing to falls, blows, or other external violence, are occasionally bent, with or without partial fracture. Within the last few years a considerable number of cases of this accident have been reported by American and European practitioners. The first regular account of it was published in 1810, by Professor Jurine of Geneva; and in 1821 a very able article on the subject appeared in the American Medical Recorder, from the pen of that distinguished surgeon, Dr. John Rhea Barton, of Philadelphia.

Simple bending is most common in the radius and ulna, though it is by no means confined to them. For obvious reasons it happens only in children, before the completion of the ossific process, or in whom there still exists a predominance of animal matter. In older persons the bones more readily break than bend. The diagnostic signs of the accident are, pain and deformity at the seat of the injury, loss of power in the limb, want of displacement of fragments, and absence of crepitation. The deformity consists in an unnatural curvature, which can be made to disappear under pressure and extension, but recurs, to a certain extent, when the limb is liberated. When attended with partial fracture, the symptoms are the same, excepting that, instead of a curvature, there is angular deformity opposite the seat of the accident. When the injury occurs in the forearm, and only one bone is implicated, extension generally produces no change in the appearance of the limb. The treatment, in both cases, is to be conducted upon the same principles as that of fractures. The attempts to remove the curvature by extension should neither be too violent nor long continued, otherwise they must prove injurious. Mr. Mantel of England, distinguished alike as an able surgeon and an accomplished geologist, thinks that the application of leeches and the usual antiphlogistic means should alone be trusted to when there is much pain and swelling, alleging that the action of the muscles will ultimately restore the limb to its natural form.—ED.]

[63] [A comparison of the results of the different kinds of treatment of disunited fracture, furnished by Dr. Norris of Philadelphia, in an able and elaborate article in the American Journal of the Medical Sciences, for January, 1842, leaves no doubt as to their relative value. Of forty-six cases in which the seton was employed, thirty-six were cured, three partially relieved, five not benefited, and two died. In twenty-one the seton was introduced with, and in twenty-four without, previous incision: of the former seventeen were cured, two improved, one failed, and one died; of the latter eighteen were cured, one was benefited, five failed, and one died. In reference to the seat of the fracture, the cases stand as follows:—

13for the femur,of which9were cured.
10”leg,”10”
16”humerus,”10”
6”forearm,”6”
1”jaw,”1”

The average period of the existence of the fracture in the above cases was nearly twelve months and a half, the longest ten years, the shortest six weeks. The mean period of the retention of the seton was seven weeks and three days. In one instance—that of a fractured humerus—it was left in thirteen months, notwithstanding which it finally failed. The average time required for the cure was nearly three months, the longest eight months, the shortest three weeks. Arterial hemorrhage occurred in two of the cases; in ten, severe fever, erysipelas, or profuse suppuration.

Of thirty-eight cases in which resection was performed, twenty-four were cured, one improved, seven failed, and six died. The seat of the injury was as follows:—

12were in thefemur,of which7were cured.
6”leg,”5”
12”humerus,”6”
7”forearm, ”5”and 1 improved.
1”jaw,”1”

The longest period of the existence of the fracture in these cases was five years, the shortest ten weeks, the average thirteen months and nineteen days. The average time required for effecting a cure was four months, the shortest one month, the longest thirteen months. In seventeen of the cases other methods of treatment had been ineffectually tried: in six the resection was followed by erysipelas, in one by phlegmasia dolens, and in two by profuse suppuration and abscesses.

Of thirty-six cases healed by pressure and rest, twenty-nine were cured, one improved, and six failed. The seat of fracture was:—

13cases in thefemur,of which 9were cured.
7”leg,”7”
12”humerus,”9”
4”forearm,”4”