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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    The fifth period extends from the 5th or 6th, to the 8th, 10th or 12th month. In this period, the external provisional callus having- served the pur- pose of keeping the ends of the bone in contact for a certain time, is entirely absorbed, while that portion of it formed by the medullary effusion, is also absorbed, and the medullary membrane returns to its natural state. The periosteum assumes its normal thickness and texture, the cellular tissue its elasticity, and the muscles, and tendons, regain their free motion. Finally, the definitive callus is wrought into cells and canals, by which the continuity of the medullary cavity of the bone is restored, and the work of consolida- tion is terminated. Such are the phenomena which accompany the formation of callus in ordinary cases, where the fractured fragments have been placed in a good position; but sometimes it happens that fractures are badly set, that is, that the ends of the broken bone instead of being placed in apposition, touch only at a single point, and nevertheless the bone becomes united. In these cases, the definitive callus never takes place, but the fragments are held together by the provisional deposit, which becomes permanent, and forms a firm bond of union. When fracture is complicated with a wound and sup- puration follows, after a lapse of time, ordinarily of several months duration, during which splinters of bone, if there be any, are thrown off, the extremi- ties of the fragments become softened and covered with vascular granulations, and unite together in a mode analogous to that of suppurating wounds of the soft parts, and it is this cicatrix, which, by a deposite of bony matter in it, constitutes the callus. From what has been stated in regard to the formation of callus, it appears, 1. That when a fractured cylindrical bone unites, a broad band or support, acting like a circular splint, and termed provisional callus, is first deposited around the seat of injury, by which the extremities are brought together and fixed. 2. That the permanent callus is formed between the ends of the bone only, and unites firmly, and closely, the fractured surfaces. 3. That when the permanent callus is produced, that first deposited, hav- ing fulfilled its transient purposes, is entirely absorbed. 4. That at the period at which splints are usually laid aside, and the union is looked upon as firm, the deposit of the permanent callus is scarcely begun, the firmness in the broken part depending solely upon the temporary deposite. With a knowledge of these facts we are enabled to explain phenomena sometimes observed after fractures, which by any of the other theories are altogether inexplicable; the renewal of the deformity after the removal of splints, at the end of a period that experience shows generally to be sufficient for a cure, the possibility of remedying by a proper and well directed treat- ment, limbs that are deformed, and why this possibility exists only during a certain time, and then ceases, are readily explained by it. They are