Fractures and dislocations / by T. Pickering Pick.

  • Thomas Pickering Pick
Date:
1885
Catalogue details

Licence: Public Domain Mark

Credit: Fractures and dislocations / by T. Pickering Pick. Source: Wellcome Collection.

    514/548 (page 502)
    coudition of the injured part. Eacli case must be treated on its own merits. Formerly amputation was considered to be necessary in every case, now a large jjercentage of limbs are saved ; some without any operative interference at all ; others by resection of the ends of the bones. If the patient is young, his constitution sound, the vessels uninjured, and the wound not too large, probably no ofjeration will be necessary; if, however, the wound Ls large and the bone projects considerably, it becomes a question whether we shall not give our patient a better chance of recovery, and with a more useful limb, by formally e.xcising the joint, than by simply reducing the bou6s and attempting to procure its consolidation with the parts ai-ound. My own feeling is strongly in favour of excision under such circumstances. When the articular surfaces are comminuted, or the bones cannot be reduced by ordinaiy force, there can be no question that excision is imjjeratively called for. I have seen very admirable results follow primary excision of the ankle joint for compound dislocation in a case uncler the care of Mr. Henry Lee, in which the boy was able to walk five miles without incon- venience and with very little limp. Amputation is only necessary when the patient is old or suliering from constitutional disease or want of power which precludes the hope of obtaining a useful limb after excision, or where the soft parts are so extensively involved as to forbid the attempt to perform this operation. If the surgeon determine to make the attempt to save the joint, the wound should be carefully cleaned and every part of the joint thoroughly s}Tmged with some antiseptic fluid, and free drainage provided for. The wound should then be closed, and firm and equable jDressure made, the linib being fixed in a box (Assalini's or JMacIntyre's) or on a back splint with a foot piece. Suppm-ation must be