Shortening of limbs after fracture / by Lewis A. Sayre.

  • Lewis Sayre
Date:
1881
Catalogue details

Licence: Public Domain Mark

Credit: Shortening of limbs after fracture / by Lewis A. Sayre. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    an overlapping and consequent shortening can he pre- vented Having seen quite a number of fractured thighs in very vigorous muscular adults, some of which had united without any shortening, that could be detected by the most careful measurement, I took the liberty of doubting Dr. Hamilton’s law, and in my “Beport on Fractures,” made to the American Medical Asso- ciation in Detroit, in 1874,1 said among other things : “ Fractures of the long bones require that extension and counter-extension under chloroform, or other an- aesthetic, if necessary, should be made in a proper direction, until perfect accuracy of adjustment is ob- tained, and after this, retention and fixation in this normal condition until consolidation. By accuracy of adjustment I mean the perfectly normal condition of the bone as to length and position. When the ex- tension and counter-extension have been properly made, the muscles and other tissues surrounding the bones will necessarily and positively force the frac- tured extremities into their natural position, as above described, unless some foreign body, as a shred of muscle or connective tissue, has got between the fragments. “ All extension beyond this point of perfect accuracy of adjustment is unnecessary and injurious ; for, be- ing abnormal, it excites reflex contractions. Hence the objection to continued extension, which keeps up reflex irritation, or else by paralyzing the muscles allows of elongation, and consequently, frequently results in non-union. “All extension short of that necessary to this per- fect adjustment is insufficient, leaving the extremi- ties of the bone as sources of irritation, and causing pain and muscular contractions as well as leaving the vessels in a looped or zig-zag position, causing the oedema heretofore described. “ The nerves also, being in an abnormal position, are additional sources of irritation, If the bone (whatever bone it may be) is thus placed and can be retained in its normal position, the patient is free