A practical treatise on fractures and dislocations

Front matter

Chap. _*____ Copyright No.

UNITED STATES OF AMERICA.

A PRACTICAL TREATISE

Preface To The Third Edition

The two volumes in which this work originally appeared were so extensively rewritten for the edition in one volume, published in 1899, that it was then practically a new book. The author gratefully acknowledges the favor which exhausted that edition in about a year, and he has endeavored to respond by again revising it to the latest date. It continues to embody the experience gained in the House of Relief (Hudson Street Hospital), where traumatic cases are so numerous as to include all the ordinary forms of injury, and most of those which are rare. So wide indeed is this clinical field that a number of lesions were first observed there and described in this work. These facts gave the opportunity for and seemed to justify a personal form for the book, with a reduction in the number of quotations of histories and of opinions based upon single cases. This enabled the author not only to introduce such additions as have been made to our knowledge of the subject in the interval, but also to adapt the work more specifically to the needs of the practitioner, especially in regard to diagnosis and treatment, while the requirements of the student of special subjects were heeded in the bibliographical references, which were largely added to.

The portion treating of Fractures was almost wholly rewritten in the edition of 1899, the most marked change in classification and arrangement being that made in the chapter on Fractures of the Skull.

In the portion treating of Dislocations, the most notable changes, in addition to those above referred to, were those dealing with operative reduction of both old and recent injuries.

The additions made in the present edition, notwithstanding the shortness of the interval, have been numerous and important. Prominent among them is that representing the advance in our knowledge of traumatic hsematomyelia and the light it has thrown upon the

VI PREFACE TO THE THIRD EDITION.

prognosis and treatment of injuries of the spinal cord, and the judgment it permits concerning the supposed efficacy of surgical interference in such cases.

Space for these additions has been gained so far as practicable by omitting old material ; but nevertheless the size of the book has been increased. Twenty new illustrations have been substituted or added, and the number of plates has been increased from twenty to thirty-two, with nineteen new figures, all but one being reproductions of

skiagrams.

Lewis A. Stimson.

34 East Thirty-third Street, New York, August, 1900.

Contents

CHAPTEE I.

Introduction

PAGE

Definitions, statistics, influences of sex, age, and season 19

Chapter II. Pathology

A. The bone ; varieties of fracture 22

1. Incomplete fractures 23

(a) Fissures ' ' 23

(6) True incomplete, green-stick ; infraction . 23

(c) Depressions • • . . . 24

(d) Separation of a splinter or apophysis 24

2. Complete fractures ; subdivided according to 25

(a) Direction and character of the line of fracture 25

(6) The seat of fracture 28

Separation of epiphysis 28

(c) Intra-articular 29

3. Multiple fractures 30

Displacements 34

B. The soft parts . . 36

Chapter III. Etiology

Predisposing causes 38

External, normal, interstitial atrophy, inherited liability 38

Determining causes 39

External violence, direct or indirect «... 39

Muscular action . . 40

Spontaneous and pathological fractures ' 43

General diseases 43

Diseases of nerve centres 45

Rhachitis, syphilis, rheumatism 45

Cancer and sarcoma t 46

Cysts, osteomyelitis 47

Intra-uterine, and during delivery 47

Chapter IV. Early Symptoms And Diagnosis

Deformity (normal asymmetry) 49

Abnormal mobility 50

Crepitus 51

Subjective or rational symptoms . 52

Loss of function ; pain 52

History . 53

vii

Vin CONTENTS.

Chapter V

REPATR OF FRACTURES AND CLINICAL. COURSE.

PAGE

Anatomo-pathological processes. The callus 55

In compound fracture 59

In short and flat bones GO

At the epiphyseal line 61

Clinical course 02

Chapter VI. Complications And Remote Consequences

Early local complications 66

Skin. Bloodvessels 66, 67

Gangrene. Degeneration of muscles . 68

Suppuration • . . 69

Early general complications 69

Septicaemia 69

Fat embolism 70

Delirium tremens, tetanus, pneumonia 71

Late local complications 71

Excessive or painful callus 71

Development of a tumor 73

Injury of a nerve 73

Weakness of callus 75

Arrest or exaggeration of growth 75

Stiffness of the joints 75

Atrophy. Thrombosis and embolism . . . 76

Chapter VII. Treatment

Reduction 79

Retention 84

Temporary and removable dressings 86

Wooden and metal splints 87

Anterior suspended splints 89

Moulded splints 90

Permanent or hnal dressings 92

Encasement in plaster 92

Traction, Buck's extension . . 94

Hodgen' s splint, long side splint 96

Vertical suspension. Double inclined plane 97

Direct fixation 98

Massage 99

Ambulatory treatment 100

Management of the joints . . 102

By indirect violence 104

By direct violence 104

Amputation 106

Compound articular fractures 107

General treatment 108