On the occurrence of non-union after fractures : its causes and treatment / by George W. Norris.

  • Norris, George W. (George Washington), 1808-1875.
Date:
[1842]
Catalogue details

Licence: Public Domain Mark

Credit: On the occurrence of non-union after fractures : its causes and treatment / by George W. Norris. 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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    followed, and no callus was formed at the end of eight months, a sinus re- maining on each side of the leg. The sinuses, at the end of the time stated, were laid open, and the dead pieces of bone extracted, by which means the impediment to the formation of callus was removed, and the fracture became firmly united in two months. Sometimes, however, the necrosis is only the remote consequence of the injury. Pieces of bone are completely broken off at the time of accident, but still retain their life, and are embedded in the provisional callus, and when the fracture is almost consolidated these lose their vitality and act as foreign substances, giving rise to inflammation, which destroys in the course of a few days all the solidity of the callus, and post- pones for a long time the cure. Mr. Amesbury (Loc. citat. p. 197) men- tions bis having seen a man with a fractured humerus accompanied with necrosis, in which no union took place, and the arm was amputated. I have myself had occasion to observe a fracture of the leg accompanied with caries, in an elderly woman, where union failed to occur, and amputation was performed by request of the patient. Hildanus, (Opera, 168, cent, ii, obs. 66,) Duverney, (Mai. des Os.) Petit, Heister, (Surgery, trans. 1763, p. 128,) and many other authors, have recorded similar facts. Interesting cases in which the development of hydatids in the medullary canal prevented the formation of callus have occurred to Webster, (New Ens;. Journ. viii, p. 29, 1819,) Wickham, (Lond. Med. and Phys. Journ. ii, N. S.,) and Dupuytren, (Journ. Hebdom., xii and ix, 1833,) and Amesbury (Op. citat. p. 197) has seen the same thing follow the existence of abscess in the bone. Mr. Amott (Lond. Med. Gaz. June, 1840) amputated the limb of a patient in Middlesex Hospital, in consequence of a fracture of the leg which had occur- red in the situation of a node, and remained ununited at the end of a year: the fibula in this case was firmly consolidated. The general rule, however, that broken diseased bones will not unite, is not absolute. Dr. Peirson (Re- marks on Fractures, p. 38, Boston, 1840) has seen repeated instances of rapid consolidation in bones so diseased as to be broken by a very small degree of force. I had a patient, says Sir B. Brodie, (Lond. Med. Gaz. xiii, p. 56, 1833,) in whom some of the bones had nodes upon them, and were much enlarged. A portion of the clavicle was enlarged, and much dis- eased besides. This man broke the collar bone through the diseased part. I bound up his arm, and it united as soon as ordinary fractures. In the fol- lowing case treated by me at the Pennsylvania Hospital, want of union was evidently kept up by a necrosed state of the inferior fragment, after the removal of which a perfect cure was effected. The patient was a healthy farmer from Clearfield county, Pennsylvania, aged thirty, who was received on the 9th of August, 1837. He stated, that on the 29th of May previously, a loaded wagon had passed over his arm and produced a simple fracture, which was dressed by a neighbour, with three board splints fastened tightly by a bandage around the injured part only. On the second day after its application, in consequence of violent pain at the seat