Treatment of fractures of long bones by simple extension / by John Swinburne.

  • John Swinburne
Date:
1861
Catalogue details

Licence: Public Domain Mark

Credit: Treatment of fractures of long bones by simple extension / by John Swinburne. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    by a strong man, will stretch the muscles to their normal length only, which fact can be shown by the most careful measurement, thus proving that the danger of too much extension is only im- aginary. With the muscles drawn out to their natural state, what becomes of the bone ? Where can it go, if not to its nor- mal position, with the fractured ends in contact ? Let any one take the cadaver, dissect out cleanly and carefully all the muscles of any long bone, leaving all their attachments entire, and after fracturing the bone at any part, make exten- sion. He will find that the fractured ends assume their normal position. Would they not equally do so in the living subject, where muscles are invested with skin, fat, fasciae, cellular tissue, and vessels ? Again, assuming the position that the extended muscles act as permanent adjusters of broken bones, and are in reality the only means by which the fracture is maintained in apposition, I ask of what use are all the mechanical appliances and apparatus called surgical splints, if not to effect the above named re- sults ? The splint beyond this possesses no practical worth ; on the contrary, it is apt, by its too careful adjustment, to impede the reparative process, by interfering with the proper circulation of the part. It is for this reason that some surgeons mal^e it a point to apply emollient dressings until the inflammation and the swelling subside. Even this delay is far preferable to the immediate application of carefully adjusted splints, bandages, etc., particularly where there is much contusion of the soft tis- sue, either from the bone within, or externally from the forces by which it was broken. Take, for example, two limbs equally con- tused, the sharp edges of the broken bone goring the muscles and nerves, the cellular tissue filled to repletion with blood, and the slightest movement causing the most excruciating pain. Sub- ject one of these to simple extension, without any incumbrance to the broken member, such as splints or bandages, apply simple warm water dressings, and in a few minutes the patient is easy and comfortable, and remains so as long as the extension is kept up. Let the other limb be adjusted by the most careful and ap- proved surgical appliances (unless these are such as keep up the extension without bandages or compression), and there will be a marked difference between the two in the degree of comfort ex- perienced. Then we may say that in extension the muscles and other in-