On the treatment of fractures of the femur by a simple modification of Liston's splint : with observations on re-fracture of the bone in cases of deformity / by Richard G. H. Butcher.

Butcher, Richard G. H., 1819-1891.

Date:: 1853

Credit: On the treatment of fractures of the femur by a simple modification of Liston's splint : with observations on re-fracture of the bone in cases of deformity / by Richard G. H. Butcher. Source: Wellcome Collection.

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$or to preserve them against being moved by the action of the muscles. The girl had, in consequence, suffered much from spasm; the limb was swollen to more than double its natural size; vesications had also formed on several parts of the skin; and there was severe symptomatic fever. The upper fragment projected much forward, and gave to the thigh a curved ap¬ pearance. The same position as that in which she had lain be¬ fore admission was persevered in; and under the use of refri¬ gerant applications a considerable reduction of the inflammation was effected by the end of the fifth day from the occurrence of the accident; but, nevertheless, during all this period a night- nurse was obliged to sit by the bedside, with her hand on the broken limb, which otherwise, on every attempt to sleep, awoke the patient with a spasm. On the morning of the sixth day she was turned on the back; the broken limb was pulled to the same length as the sound one; permanent extension was kept up by Desault’s splint, applied on the outside; a corre¬ sponding long splint was placed along the inside, and a short one was laid on the front, so as to make pressure on the pro¬ jecting end of the broken bone. Long pads of bran were inter¬ posed between these and the limb, and the whole secured to¬ gether by broad straps and buckles, in such a manner that the limb was subjected on every part to moderate and uniform pressure. “ The business of altering the position of the patient, and of setting the fracture, was productive of much pain ; and no doubt, had the operation been practised in the first instance, not only would the amount of suffering caused by it have been comparatively trifling, but most probably the distressing spasms and inflammatory swelling, borne during the first five days, might have been averted; for, from the moment in which the limb was settled, as has been just described, all tendency to de¬ ranged action of the muscles ceased, the girl slept soundly, and the tumefaction rapidly subsided. She expressed herself as much more comfortable in her new than in her old position, and got well rapidly, without any farther untoward symptom. She walked out of the hospital on the 20th of August, without any appreciable difference, as to the shape or length, between the unbroken and mended limb.” Dr. Houston goes on to say:— “ The treatment, by permanent extension, of fractures of the femur close to tlie trochanter, is not, it will be observed, that which is usually practised in such cases, but it was here most completely successful; and I might state other instances in which I have adopted it with equal effect. I might also$