Orthopædic surgery : a handbook / by Charles Bell Keetley.

  • Keetley, Charles Bell.
Date:
1900
Catalogue details

Licence: In copyright

Credit: Orthopædic surgery : a handbook / by Charles Bell Keetley. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    bone, if hard, will break in two before you have cut out your wedge—a troublesome occurrence. Apply pressure before taking off the Esmarch. There is no necessity for putting ligatures into any ordinary osteotomy wound ; their insertion can only increase the chances of suppuration or delayed healing. A short period of sponge pressure usually suffices to check oozing. If wood-wool pads be used, they may be applied at once ; the elastic pressure which can be got by bandaging over these pads will suffice, but always during the first twenty-four hours keep the limb raised (at first nearly to the perpendicular). With regard to splints, they should be re- movable during the first fortnight and immovable afterwards. I used to fix in plaster of Paris at once; but that plan in the long run involves waste of time, and, moreover, waste of time at a very inconvenient moment, namely, while some other patient is waiting to be operated on ; moreover, it is not right to keep on for more than a day the pressure often necessary to check haemorrhage; also, the thick first dress- ings, when removed, leave such a space in a primary plaster- case that it no longer fits, there- fore I postpone fixation in plaster for a fortnight. By that time little or no dressing is required, the wound being healed, or nearlj'^ so. A large wood-wool cushion does itself serve for both splint and dressing during the first fortnight in some cases ; if not, it can be supplemented by an ordinary wooden box-splint or a trough of poroplastic, or almost any other simple and quickl}' applied contrivance. When the plaster-case is ap])lied, the greatest pains must be taken to obtain perfect position ; five weeks, dating from the day of operation, usually suffice to obtain firm union. During the whole of the time the patient should be kept in hospital, unless a private case. Whoever attempts to deal with these cases in the out-patient depart- FiG. 41.—Slight Eickets simu LATiNG Talipes Varus.
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