Fractures and dislocations.

  • Thomas Pickering Pick
Date:
1885
Catalogue details

Licence: Public Domain Mark

Credit: Fractures and dislocations. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

    41/548 (page 29)
    Chap. III.] Impacted Fractures. swelling allows us to examine the part with more jDrospect of clearing up our doubts. This is especially essential if fixed pain in one particular part of the bone is complained of. It remains now to say a word or two on the symp- toms of some special forms of fracture, in so far as they differ from the signs of ordinary fracture. Impacted fractures.—The presence of impac- tion often renders the diagnosis of fracture very difficult. In consequence of the one fragment being di'iven into and fixed in the other, two of the most prominent signs of fracture are of necessity absent, that is to say, crepitus and increased mobility in the continuity of the bone. The presence also of a considerable amount of swelling may mask any displacement which may exist, and will add to the difficulties. The surgeon must be guided in forming an opinion, first of all, by the history of the accident, being such as would not only produce a fracture, but also, from the direction of the violence, would have a tendency to impact or force the one fragment into the other ; secondly, by the seat of the injury, e.^. if it occurs at the extremity of a long bone, where the part im- pacted consists of loose cancellous tissue, while the impacting portion is compact, solid bony tissue ; and, thirdly, by the deformity or distortion present whether it is characteristic of the particular fracture. Incomplete fractiu-es—The signs which indi- cate the presence oi^ fissure of a bone are not sufficiently marked to render a diagnosis by any means certain, ihe presence of fixed pain in one particular spot in a bone after the receipt of a severe injury, probably from direct violence and the appearance of a linear ecchy- mosis, after the lapse of a few days would justify us m assuming that a fissure of the bone had taken place, though It would not entitle us definitely to state that such was undoubtedly the case.