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.)

    22/55
    between the bones, and so remain until a proper position is given to the limb and the fragments perfectly reduced; and where from the size of the interve- ning part this cannot be at once done, the mere continued pressure of the ends of the bone would in a very short time, if properly adjusted, either cause its absorption, or else cause it to take on the ossific action. The inter- position of any soft parts between the ends of a fractured bone, is justly regarded by Mr. Key (Lond. Med. Gaz. iv, p. 264) as a mere excuse for the occurrence of non-union. It is the duty of the surgeon, he observes, when he examines into the nature of the accident, and places the limb in splints, to ascertain that the fractured ends grate together; and if muscle is interposed, to make extension in order to disengage the broken extremity. The case mentioned in the Dictionary of Cooper, on the au- thority of Sir James Earle, is often quoted to show the possibility of mus- cular substance forming an impediment to the union after fractures. He says, I have seen a woman, under Sir James Earle, in the above hospital, (St. Bartholomew's,) whose os brachii did not unite, though it had been broken several months. Every attempt to move the bone occasioned excruciating torture. The woman died of some illness in the hospital; and, on dissecting the arm, the cause of the fracture not having united was found to arise from the upper, sharp, pointed extremity of the lower portion of the broken bone having been forcibly drawn up by the muscles, and penetrated the substance of the biceps, in which it still remained. From this it is clearly evident that the fracture was oblique, and the fragments much dis- placed; and this want of apposition in the fragments is surely alone a suffi- cient cause for the non-union, without seeking for it in the interposition of muscular fibres between the fragments. Besides, it is well ascertained that muscle, as well as all the other parts surrounding a fractured bone, contribute more or less to the formation of the callus. An interesting preparation going to support this view, and much to the point in this particular matter, is men- tioned in the Dictionnaire de Medecine (xiii, art. Fract. 2d ed.) as having been presented to the Anatomical Society of Paris, in which the fragments of a clavicle, separated to the extent of an inch by the subclavian muscle, were united together very solidly by two bridges of newly-formed bone, in the centre of which the muscle, itself ossified, was imprisoned. 5th. Tight bandaging.—That a tight bandage may prevent the restora- tive process from taking place there can be no doubt. Duverney (Diseases of the Bones, trans, by Ingham, p. 171, 1762) thinks, nothing in simple fractures so much opposes the formation of callus as a too tight bandage. Pare, (Works, trans, by Johnston, p. 379, 1649,) and Wiseman, (Chirurgi- cat Treatises, ii, p. 256, 5th ed. Lf>nd. 1719,) also caution us in regard to its employment. Sir B. Brodie explains its modus operandi, by supposing that the fracture does not receive a sufficient quantity of blood to allow of the process to go on; but M. Malgaigne, with more reason, attributes it to the pressure preventing the deposit of the provisional callus. In support of the