A text-book on minor surgery

Front matter

Class ~1f?X^ Book__iV_3 .

ill fopyrigM^?-.

COPYRIGHT DEPOSIT,

Preface

During the last decade while surgery has shared in the great advance made by all the sciences, one of its branches, minor surgery, has far outstripped the others. This has been caused by a great number of factors. The industrial clinic, the workers compensation insurance, the use of local anesthesia, and the realization of the far-reaching results and complications of poorly and improperly treated minor injuries have been responsible for the prodigious strides of this branch. The disfiguring scars of burns, the stiff fingers, due to neglected tendon sheath infections, and other such conditions so important to the individual both socially and economically have left their indelible imprint upon all surgeons, stimulating them to a keener interest in this formerly unimportant division of surgery.

To give detailed description of the widely different methods of treating the same surgical condition would fill many volumes, and would fall far beyond the scope of this book. In the chapters which follow an attempt has been made to give those surgical procedures which are simple and efficient. In their selection it has always been borne in mind that while complicated treatments may yield better results in the hands of their originators, complete failure has often met the attempts of those not skilled in the involved technic.

A work on Surgery has long since ceased to be the product of an individual. We, therefore, extend our heartiest thanks to other authors, our predecessors and teachers; and for much help to Doctors G. M. Phelps and Ralph Colp, and also to Grace Adams and Emma Renick.

J. C. V.

A. C. B.

New York, 1922.

CHAPTER I. General Injuries to the Soft Parts

Abrasions 17

Contusions ' 18

Hematoma of the Soft Parts 19

Prevention of Infection 20

Control of Hemorrhage ' 21

Suture of Wounds ' 22

Drainage 26

Suppurating Wounds . 28

Puncture Wounds . 28

Contused Wounds 29

Lacerated Wounds 29

Subcutaneous Injuries to the Soft Parts 29

Rupture of Muscle or Strain 30

Rupture of Tendons 30

Rupture of the Bloodvessels 30

Rupture of Nerves 32

Burns and Scalds 32

Sunburn 36

Effects of Intense Cold 36

Chilblains 36

Frost-bite 37

Frost-bite of the Abdominal Wall 38

Specific Infections 38

Erysipelas 39

Tetanus 39

Anthrax 40

Hydrophobia . 41

CHAPTER II. Fractures in General

Symptoms 42

Special Varieties of Fractures 49

Separation of the Epiphyses 49

Greenstick Fractures 50

Spontaneous Fractures 50

Temporary Treatment 51

Reduction 51

Retention of Fractures -.-.•.. . . . . . 51

Restoration of Function 58

Compound Fractures 59

Hemarthrosis and Traumatic Arthritis 60

Hematoma . . 60

Paralysis 60 vm CONTENTS

Ischemic Contraction 60

Stiffness of the Muscles 61

Thrombosis and Embolism 61

Delayed Union 61

Faulty Union 62

Roentgenographic Control 63

CHAPTER III. Injuries to Joints

Dislocations 64

Complications of Dislocations 68

Fracture 68

Injury to the Bloodvessels 68

Habitual Dislocation 68

Compound Dislocation 69

Subluxation 69

Treatment of Dislocation . 69

Reduction 69

Retention 70

Restoration of Function 72

Old Dislocations 72

Congenital Dislocations 72

Sprains 72

Sprain-fracture . 75

Traumatic Synovitis 75

Wounds of the Joints 77

Gunshot Wounds 79

CHAPTER IV. Inflammation, Suppuration and Gangrene

Inflammation 81

Acute Abscess 99

Senile Gangrene 105

Raynaud's Disease 106

Diabetic Gangrene 106

Gangrene from Ergot Poisoning . . . . 106

Phenol Gangrene 106

Bed-sore or Decubital Gangrene 107

Noma 108

Gas Gangrene 108

CHAPTER V. Injuries to the Head

Abrasion of the Face and Scalp 110

Contusions of the Scalp 110

Hematoma of the Scalp Ill

Hematoma in the New-born 113

Contusions of the Face 114

Contusion of the Eye 114

Contusion of the Ear 115

Contusion of the Nose 115

Foreign Bodies in the Head and Face 117

Powder Grains in the Skin 117

Foreign Body in the Eye .... 118

CONTENTS ix

Foreign Bodies in the Head and Face — ■

Foreign Bodies in tjie Ear 119

Foreign Bodies in the Nose 119

Foreign Bodies in the Mouth and Throat 119

Foreign Body in the Larynx or Trachea 120

Wounds of the Head and Face 120

Wounds of the Scalp 121

Wounds of the Face 122

Wounds of the Mouth 122

Wounds of the Eye, Nose and Ear 123

Burns of the Head and Face 123

Burns of the Mouth 124

Burns of the Eyes . 124

Chemical Burns of the Face 124

"Mustard Gas" Burns 125

Fracture of the Skull 125

Fractures about the Face 1 28

Fracture of the Nose 128

Fracture into the Frontal Sinus 129

Fracture of the Malar Bone 129

Fracture of the Superior Maxilla . 130

Fracture of the Zygomatic Arch 130

Fracture of the Mandible 130

Dislocation of the Mandible 132

Inflammation of the Head and Scalp 133

Simple Herpes 133

Herpes Zoster 133

Impetigo Contagiosa 134

Boils and Furuncles 134

Sty or Hordeolum 136

Carbuncle 137

Cellulitis of the Scalp 137

Cellulitis of the Face 139

Ringworm of the Scalp 139

Abscesses 139

Alveolar Abscess 139

Peritonsillar Abscess 142

Retropharyngeal Abscess 143

Suppurative Parotitis 143

Erysipelas 144

Anthrax 144

Actinomycosis 145

Glanders 145

Syphilis "... 146

Primary Lesion 146

Secondary Lesions 147

Tertiary Lesions 147

Tuberculosis 148

Lupus Vulgaris 148

Tuberculous Ulcers 150

Moles 150

Papilloma or Warts 151

Angioma 151

Sebaceous Cysts 152

Dermoid Cyst 155

Congenital Sinus 157

Cysts and Calculi of the Mouth 157

Mucous Cysts 157

Ranula 157

Parotid Cyst 158

Salivary Calculi 158

Salivary Fistula .... ... 159

X CONTENTS

Benign Tumors of the Face . . . : . . . 159

Osteoma 160

Fibroma 161

Cutaneous Horn 161

Epithelioma - 163

Superficial Epithelioma 163

Deep-seated Epithelioma . . 164

Papillary Epithelioma 165

Epithelioma of the Lip . . 166

Epithelioma of the Tongue 168

Sarcoma of the Face 169

Epulis 170

Parotid Tumors 170

Disfiguring Scars . 172

Ectropion 172

Plastic Operations on the Nose 173

Partial Loss of Ala or Tip 173

Loss of Cartilaginous Portion 174

Loss of Bridge of Nose 174

Harelip ■ 174

Tongue-tie 175

Cleft Palate 175

Plastic Surgery of the External Ear . . . . . 170

Colomba 176

Macrotia, or Enlargement of External Ear 176

Auricular Appendages 177

Malposition of the Ear 177

Deformities of the Cheeks . .177

CHAPTER VI. Injuries and Inflammations of the Neck

Wounds of the Neck 178

Wounds of the Trachea . . . . . . . 178

Tracheotomy 179

Intubation 181

Wounds of the Esophagus 181

Contusions of the Neck 181

Sprains of the Neck 182

Burns of the Neck 182

Septic Infection of the Neck 182

Boils . * 183

Carbuncle of the Neck 184

Abscess of the Neck 186

Angina Ludovici 187

Acute Lymphadenitis 187

Chronic Lymphadenitis 189

Tuberculosis of the Cervical Lymph Nodes 191

Fractures and Dislocations of the Neck 198

Fractures of the Cervical Vertebrae 198

Dislocation of the Cervical Vertebrse 199

Fracture of the Hyoid Bone 200

Fracture of the Larynx 200

Fracture of the Trachea 201

Hair Cysts 201

Branchial Cysts 201

Hygroma 202

Thyroglossal Cysts ... 203

Tumors of the Thyroid Gland .203

Lipoma 206

CONTENTS xi

CHAPTER VII. Special Surgical Conditions of the Trunk

Contusions of the Trunk 208

Contusions of the Chest 208

Contusion of the Abdomen 209

Wounds of the Trunk 211

Wounds of the Chest 211

Wounds of the Abdomen 211

Sprain of Back 212

Herpes Zoster 214

Minor Operations for Pleurisy and Empyema 215

Exploratory Puncture 215

Aspiration of the Chest 215

Minor Operations for Empyema 217

Abscess of the Breast 219

Chronic Lobular Mastitis 222

Tuberculosis of the Mammary Gland 222

Tumors of the Nipple • 223

Benign Tumors of the Breast 224

Hypertrophy of the Breast 225

Tuberculosis of the Region of the Trunk 225

Tuberculosis of the Ribs . 226

Aspiration of a Cold Abscess 228

Tuberculosis of the Lymph Nodes 228

Artificial Pneumothorax 229

Surgical Disease of the Umbilicus 229

Hemorrhage 229

Umbilical Hernia 229

Umbilical Sinus 230

Suppuration of the Umbilicus 231

Tumors of the Trunk 232

Keloid 232

Desmoid 235

Epiplocele 235

Cystic Growths 236

Fracture of the Clavicle 237

Fracture of the Sternum 240

Fractures of the Ribs 241

Fracture of the Costal Cartilages 243

Fracture of the Vertebrae 244

Fracture of the Pelvis . . 244

Fracture of the Crest of the Ilium 244

Fracture of the Spinous Process of the Ilium 245

Fracture of the Coccyx 245

Dislocation of the Clavicle 245

Dislocation of the Costal Cartilage 246

Dislocation of the Sternum 246

Dislocation of the Coccyx 246

CHAPTER VIII. Fractures and Dislocations of the Hand and Arm

Fractures about the Shoulder 247

Fracture of the Coracoid 247

Fracture of the Acromion 247

Fracture of the Body of the Scapula 247

Fracture of the Neck of the Scapula 248 xil CONTENTS

Fracture of the Greater Tuberosity 248

Fractures of the Surgical Neck of the Humerus 249

Fracture of the Shaft of the Humerus 251

Fractures of the Lower Extremity of the Humerus 251

Separation of the Lower Epiphysis of the Humerus 254

Fracture of the Olecranon ....'..... 254

Fracture of the Coronoid Process 255

Fracture of the Head of the Radius 256

Fractures of the Forearm in Children 259

Epiphyseal Sprain 261

Colles' Fracture 261

Chauffeur's Fracture of the Radius 264

Fractures of the Carpus 267

Scaphoid 267

Fractures of the Semilunar and Os Magnum 268

Fracture of the Metacarpals 268

Fracture of the Sesamoid Bones 274

Dislocations of the Shoulder 274

Dislocation of the Elbow 277

Subluxation of the Head of the Radius . 280

Dislocation of the Wrist 280

Dislocation of the Carpal Bones 280

Dislocation of the Semilunar 280

Dislocation of the Metacarpal Bones 281

Dislocation of the Thumb 281

Dislocation of the Phalanges 282

Dislocation of the Thumb 282

Dislocation of the Fingers 283

CHAPTER IX. Injuries of the Arm and Hand

Contusions of the Arm and Hand 286

Wounds of the Arm and Hand ' 286

Blank-cartridge Wounds 288

Nerve Injuries 289

Muscle Injuries 291

Wounds of Muscles . 291

Muscle Strain . 291

Rupture of Biceps Muscle , 292

Rupture of the Triceps Tendon 293

Rupture of the Long Extensor of the Thumb 293

Wounds of Tendons 293

Dislocations of Tendons 294

Traumatic Synovitis 294

Mallet-finger . 295

Fracture of the Nail 296

Subungual Hemorrhage 297

Lacerated and Compound Fracture of Finger Tip 298

Traumatic Amputation of the Fingers 299

Extensive Crushing of the Fingers . 299

CHAPTER X. Acute Infections of the Upper Extremity

Erysipelas and Erysipeloid 303

Erysipeloid • 303

CONTENTS xiii

Ringworm (Trichophytosis) 304

RingY^orm of Nails (Trichophytosis Unguium 304

Lymphangitis of the Hand 306

Abscess of the Hand 314

Suppurative Tenosynovitis 314

Suppurative Arthritis 319

Osteomyelitis 320

Osteomyelitis of the Hand 320

Special Infections, of the Upper Extremity 321

Cellulitis of the End of the Fingers (Felon) 321

Paronychia 323

Cellulitis of the Interdigital Web 323

Infection of the Hair Follicles 324

Cellulitis of the Forearm 325

Supracondylar Abscess . . . . • 326

Abscess of the Axilla 326

CHAPTER XI. Miscellaneous Affections of the Hand and Arm

Bursitis 328

Subdeltoid Bursitis . . 328

Olecranon Bursitis 330

Arthritis of the Fingers 332

Gonorrheal Arthritis 332

Gouty Deposit 334

Tuberculosis of the Arm and Hand 334

Tuberculous Arthritis 334

Tuberculosis of the Tendon Sheaths 334

Non-tuberculous Tenosynovitis 335

Tuberculosis of the Phalanges (Spina Ventosa) 336

Syphilis of the Hand and Arm 338

Syphilitic Dactylitis 339

CHAPTER XII. Tumors and Deformities of the Arm and Hand

Neuroma . 340

Neurofibroma 340

Fibroma 340

Lipoma 341

Hygroma 342

Sebaceous Cyst 343

Papilloma 343

Osteoma 344

Ganglion 344

Synovial Warts 346

Malignant Tumors of the Arm and Hand . . 347

Carcinoma 347

Sarcoma 348

Congenital Deformities of the Arm and Hand 349

Polydactylism 349

Syndactylism 350

Dupuytren's Contraction 352

Cicatricial Contraction 354

Ischemic Muscular Paralysis 355

Deformities Secondary to Nerve Injury 357 xiv CONTENTS

CHAPTER XIII. Fractures and Dislocations of the Lower Extremity

Minor Fractures of the Thigh 359

Fracture of the Neck of the Femur 359

Fracture of the Greater Tuberosity 359

Fracture of the Lesser Trochanter 360

Fracture of the Epicondyle 360

Fracture of the Patella 361

Minor Fractures of the Leg 365

Separation of the Tubercle of the Tibia 365

Fracture of the Fibula 366

Fracture of the Shaft of the Fibula 366

Fractures about the Ankle 368

Pott's Fracture . . 368

Fracture of the Internal Malleolus 371

Fracture of the External Malleolus . . 372

Oblique Fracture of the Lower End of the Tibia 372

Minor Complaints Following Fractures about the Ankle 372

Fractures of the Tarsus 375

Fracture of the Astragalus 375

Fracture of the Os Calcis 376

Fracture of the Sustentaculum Tali . ... . . ..... ... . 376

Fracture of the Scaphoid 376

Fracture of the Cuboid and Cuneiforms 377

Fractures of the Metatarsals and Phalanges . 377

Fracture of the Metatarsals 377

Fracture of the Sesamoid Bones 379

Dislocation of the Patella 379

Dislocated Meniscus 381

Dislocations of the Fibula 382

Dislocation of the Tarsus 382

Subluxation of the Fourth Metatarsal 382

Dislocation of the Toes 383

CHAPTER XIV. Injuries to the Leg and Thigh

Hematoma 384

Wounds of the Knee-joint 385

Injuries to Nerves and Muscles 387

Rupture of the Plantaris Tendon . . . . . 388

Rupture of the Quadriceps 389

Acute Synovitis of the Knee 390

Chronic Synovitis of the Knee 391

Loose Bodies in the Knee 394

Prepatellar Bursitis 394

Suppurative Bursitis 396

Other Varieties of Bursitis 397

Sprain 398

Sprained Ankle 398

Sprain of the Knee 399

Sprain of the Hip ... . 399

CHAPTER XV. Miscellaneous Affections of the Leg and Thigh

Lymphadenitis 400

CONTENTS xv

Lymphadenitis —

Bubo 400

Abscess of the Popliteal Space 402

Varicose Veins 402

Phlebitis and Thrombosis 404

Postoperative Phlebitis 404

Phlebitis of Varicose Veins 406

Localized Phlebitis 406

Chronic Ulcers of the Leg 407

Deformities of the Legs and Thigh 412

Bow-legs 413

Knock-knee 413

Tumors of the Leg 414

Osteoma 414

Carcinoma 415

CHAPTER XVI. Minor Surgery of the Foot

Injuries of the Foot 416

Sprains of the Foot . . . . . 417

Amputation of the Toes ' 418

Puncture Wounds of the Foot 420

Cellulitis of the Foot 422

Hallux Valgus 433

Hollow or Contracted Foot 435

Morton's Disease • . 436

Achillodynia 437

Painful Heel 437

Hammer-toe 438

Tenosynovitis about the Ankle 438

Ringworm of the Foot (Trichophytosis Pedis) 440

Dermatitis of the Foot 441

Perforating Ulcer of the Foot 441

Gangrene of the Foot . 443

Ingrowing Toe-nail 444

Clavus or Corn 446

Callosities 447

Plantar Wart : . . 447

Deformities of the Foot 448

Congenital Deformities 448

Acquired Deformities 449

CHAPTER XVII. Affections of the Rectum and Anus

Wounds of the Rectum . 450

Foreign Bodies in the Rectum 451

Deformities of the Anus and Rectum 451

Imperforate Anus 451

Anal Fissure 453

External Hemorrhoids 454

Internal Hemorrhoids 455

Dilatation of the Sphincter 456

Intertrigo of Anus 457

Pruritus Ani ■ 458

Ischiorectal Abscess 458

Fistula-in-ano 461

Prolapse of the Rectum 465

Polypus of the Rectum 467

Ulcers of the Rectum and Anus 468

Coccygeal Cysts 470

Malignant Tumors of the Rectum and Anus 470 xvi CONTENTS