Fractures and dislocations, diagnosis and treatment

Front matter

t^ c^ xOq.

A^

FRACTURES

Foreword

The object of this book has been to offer the reader a working knowledge of the subject in as few words as possible, avoiding for the most part all theories and arguments w^hich are void of practical value for the surgeon who has to diagnose and treat the various injuries which are met with in actual practice. The author has endeavored to make the reader an eye witness to the various deformities as they appear immediately following the accident, rather than to offer him lengthy text in describing the lesions. There is much to be learned by inspection in the average case of fracture or dislocation, and the information thus gained may be put to immediate use with a minimum amount of manipulation of the parts and without being obliged to await the returns of an X-ray examination. The more one learns by inspection, in establishing a diagnosis in a given case, the less there remains to be determined by palpation, and if the surgeon develops the faculty of recognizing what he sees the patient will many times be relieved of much unnecessary manipulation and suffering to say nothing of the damage which may be inflicted on the already traumatized soft tissues. Photography, therefore, is the best means of recording the initial deformities, but the excitement, confusion and pain attending the average case of fracture are conditions anything but favorable for picturetaking. Moreover the varying conditions of light and the surroundings in which we find the patient, together with the necessity of having the photographic apparatus available and in good working order, are additional factors which work against the securing of such valuable clinical data and explain the scarcity of pictures of these deformities in medical literature. The illustrations of such deformities shown on the following pages have been taken under unfavorable circumstances, in a large proportion of cases, and (although the photographic appliances were the best obtainable including the fastest Goerz and Zeiss anastigmat lenses) the results, from a photographic standpoint, have been none too good in many instances. The pictures shown have been chosen from a large number of such photographs with the intention of

Vlll FOREWORD

familiarizing- the reader with the average clinical deformity, rather than for the purpose of recording rare cases or those in which the pathology is obscure.

The time-honored, academic classification of fractures under one heading and dislocations under another has been abandoned, and the more practical method of considering the injuries according to the region in which they occur has been followed. Thus the reader will find all the injuries to which a given region is subject (including fractures, dislocations, joint fractures and fracture-dislocations) without looking up the different conditions in widely separated sections of the book or even consulting another volume.

The development of the Rontgen ray has been of inestimable value in the diagnosis of fractures and dislocations, and its use cannot be too highly commended; but, on the other hand, this very aid has resulted in our becoming more lax in other methods of diagnosis. The X-ray is a most valuable supplement to other physical clinical methods but it should not be expected to supplant them. The surgeon should make a practice of determining the nature and location of the fracture as accurately as possible (due care being exercised to avoid unnecessary manipulation) before the X-ray is taken, and later to compare his conception of the condition with the Rontgenogram. By making this a routine measure he will find that his diagnostic acumen will be materially increased as time goes on.

A certain mechanical sense is most essential in the treatment of fractures and dislocations, and no text-book can supply this to one naturally deficient in this respect. However, an attempt has been made in the following pages to supply the necessary data for the development of this sense and to place before the reader, as far as possible, some of the author's experiences.

The more common fractures have been accorded the greatest amount of attention since they are the conditions with which the average practitioner will have to deal most frequently.

Occasion is here taken to thank a number of members of the medical profession in Denver who have been of service in various ways in obtaining the material for and in the preparation of this work. Among others the author wishes particularlj^ to express his gratitude to: Drs. C. B. Lyman, T. E. Carmody, Leonard Ely, H. R. McGraw, Benj. :D^Iatthews, V. D. McKelvey, J. M. Barney,

FOREWORD IX

R. K. Beere, W. G. Mudd, C. B. Ackley, H. G. Harvey, Tracey Love, E. AV. Lazell, W. M. Wilkinson, S. B. Childs, L. G. Crosby, J. B. Davis, Mr. Frank Barmettler and members of the staff and internes of the City and County Hospital.

Due credit for the few illustrations not original is given in the legends accompanying them.

The chapter on the use of the Rontgen ray is written by Dr. H. G. Stover, and most of the Rontgenograms have been taken for me by him, or have been drawn from his collection of over thirteen thousand plates.

Miller E. Preston.

Denver, Colorado.

Part I. Upper Extremity

Chapter ^

Page

1. Fractures of the Clavicle and Injuries to the Clavicular Articulations 3

II. Dislocations of the Sternal End of the Clavicle

III. Fractures of the Clavicle . .

ly. Dislocations of the Outer End of the Clavicle

V. Fractures of the Scapula

VI. Dislocations of the Shoulder

VII. Fractures of the Upper End of the Humerus

VIII. Fractures of the Shaft of the Humerus

IX. Fractures of the Lower End of the Humerus

X. Dislocations of the ELBovt^

XI. Dislocations of the Ulna Alone (Rotary)

XII. Dislocations of the Head of the Radius .

XIII. Fractures of the Bones of the Forearm

XIV. Fractures of the Upper End of the Ulna . XV. Fractures of the Upper End of the Radius

XVI. Fractures of the Radial and Ulnar Shafts . XVIL Fractures of the Lower End of the Ulna XVIII. Luxations of the Lower End of the Ulna . XIX. Fractures of the Lower End of the Radius XX. Injuries to Carpus (Dislocations of Wrist, Medico-car PAL Luxations and Fractures and Dislocations of the

Individual Carpal Bones) .277

XXI. Luxations of the Carpometacarpal Articulation . . 294 XXII. Fractures of the Metacarpals . . 297

XXIII. Fractures of the Fingers 307

XXIV. Dislocations of the Fingers . . .314

Part II. Head And Trunk

XXV. Fractures of the Nose . 323

XXVI. Fractures of the Malar Bone and Zygomatic Arch . . 334 XXVII. Fractures of the Superior Maxilla .... . . 343

XXVIII. Fractures of the Lower Jaw 348

XXIX. Dislocations of the Jaw 376

xi

Xll CONTENTS

Chapter Page

XXX. Scalp Wounds 379

XXXI. Fractures of the Skull . . 391

XXXIi. Fractures of the Sternum ... 453

XXXIII. Fractures of the Ribs 459

XXXIV. Fracture-Dislocations of the Spine 465

XXXV. Fractures and Dislocations of the Pelvis .... 492

Part III. Lo^ver Extremity

XXXVI.

XXXVII.

XXXVIII.

XXXIX.

XL.

XLJ.

XLll.

XLIIl.

XLIV.

XL\ .

XLVI.

XLVII.

XLVIII.

XLIX.

L.

LI.

LIl.

LIIl.

LI\ .

LV.

LVI.

Fractures of the Upper End of the Femur . . . .531

Fractures of the Lower End of the Femur .... 574 Fractltres and Luxations of the Semilunar Cartilages . 587

Dislocations of the Patella 609

Dislocations of the Knee 613

Injuries Just Below the Knee — Fractures of the Tibia

AND Fibula (Upper Ends) 620

Fractures of the Shafts of the Bones of the Leg . . 634

Fractures of the Loaver Ends of the Tibia and Fibula . 675

Fractures and Dislocations of the Astragalus . . . 692

Subastragalar Luxations 699

Fractures and Dislocations of the Calcaneum . . . 703

Medio-Tarsal Luxations 709

Fractures and Luxations of the Cuboid, Scaphoid and

Cuneiforms 710

Tarso-Metatarsal Luxations 713

Fractures and Luxations of the Phalanges .... 720