Licence: Public Domain Mark
Credit: A report on excisions of the head of the femur for gunshot injury. Source: Wellcome Collection.
138/156 (page 130)
Licence: Public Domain Mark
Credit: A report on excisions of the head of the femur for gunshot injury. Source: Wellcome Collection.
![requiring ligature will rarely be wounded. It is best to open the capsular ligament, freely on its anterior and inferior aspect. This can readily be accomplished if the external straight incision is long enough. Otherwise, the incision should curve forward slightly at its upper part. Unless the preliminary incisions are faulty, the division of the round liga- ment and exarticulation present no difficulty. The next best plan is by the semi-lunar flap with its convexity upwards. This affords greater facility in exarticulation and in resecting the upper extremity of the femur; but it involves the risk of haemorrhage, and leaves a more serious wound. After repeatedly performing the latter operation until the year 1866, Dr. B. von Langenbeck (Op. cit, p. 24) discarded it as too dangerous, and substituted a longitudinal incision The other forms of flap operation are to be con- demned, as well as the complex crucial incisions, although it may be occasionally advisa- ble to vary the direction of the external incision in order to include the entrance or exit wounds of the ball. It is well to have regard to the position of wounds made by the pro- jectile within certain limits; but to make the preliminary incisions through the nates or adductor muscles, as practiced by Drs. Cullen and Dubois, because the entrance wounds were in these localities, is to expose the patient to unnecessary perils. Many surgeons recommend that the great trochanter should always be removed, whether injured or not, a precept based apparently on theoretical grounds, and not deduced from experience. The method of operating, though important, is far less essential than the after-treat- ment. In this, complete immobility of the injured limb is the first requisite. In opera- tions in field hospitals, the surgeon should be assured that he can secure at least temporary rest for his patient, and subsequent safe transportation. The premature removal of patients who have undergone excisions, from permanent hospitals, cannot be too severely repre- hended. When the patient is to be un- disturbed, many surgeons prefer to sim- ply support the limb in a proper position by cushions and pillows, with addition, perhaps, of slight extension by weights, l| according to the plan of Dr. Buck. Others prefer the flexed position, and, in the pri- mary Operations in the -American War Fig. 70.—Dressing for excision of the head of the femur. [After Fergusson.] it was common to suspend the limb in the wire splint devised by Dr. N. R Smith, as the safest mode of providing for the transportation in an ambulance wagon over a rough road, to which the patient would probably be subjected. When patients were treated in stationary hospitals, the advantages of treatment in the straight position, with moderate extension, were generally recognized. Sir W. Fergusson's plan of making the counter-extension from the opposite thigh was found to answer well The apparatus recommended by this distinguished surgeon, which is figured in the accompa- Fig. 71.—Brar.ketted splint for excisions of the head of the femur. [After Erichsen.]'](https://iiif.wellcomecollection.org/image/b20421758_0138.jp2/full/800%2C/0/default.jpg)
