A practical treatise on fractures and dislocations / by Frank Hastings Hamilton.
- Frank Hastings Hamilton
- Date:
- 1891
Licence: Public Domain Mark
Credit: A practical treatise on fractures and dislocations / by Frank Hastings Hamilton. Source: Wellcome Collection.
Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.
106/858 page 112
![Stephen Smith, of New York, has seen two examples;1 Lonsdale mentions three ;2 and Gibson has seen one ;3 and I have met with two, both of which are recorded in the early editions of this book. Velpeau, Fergusson, Gibson, Henry Smith, and others, have remarked that a separation at the symphysis takes place usually in infancy or childhood. But in the examples in which I find the ages reported, only one, a case mentioned by Lonsdale, occurred in a person as young as ten years; in one of the cases seen by myself, the patient was seventeen years old, and the remainder ranged from twenty-five years to sixty; and the average age of all is thirty-two years. A fracture of the ramus occurred in a man twenty-three years old, who had been struck by a wooden block on the side of his face. The ramus was broken just above the angle, and the body was broken, also, obliquely near the symphysis. The intercepted fragment was carried inward.4 I met with another similar case at Bellevue Hospital, in a woman. Ledran mentions the case of a child, ten or twelve years old, in whom the fracture was double also; one fracture having taken place through the body, and one extending obliquely from the root of the coronoid process to the neck of the condyle. The intercepted fragment was, however, so little displaced that the fracture of the ramus was not discovered until after death.5 Malgaigne refers to this as the only example recorded; but Stephen Smith, of the Bellevue Hospital, has met with it four times: in one case the ramus was broken on both sides; in two cases one ramus only was broken; and in one the body was broken on the right side and the ramus on the left.6 In two of these examples the fragments were not displaced. The coronoid process is so well protected by muscles and by the sur- rounding bony projections, that it is very rarely broken. Houzelot mentions a case in which a fall from a height produced at the same time a fracture of both condyles, of both coronoid processes, and of the sym- physis.7 Nine cases of fracture of the condyles have been reported, in all of which the separation occurred through the neck, and just below the insertion of the external pterygoid muscle. According to Malgaigne, the analysis of these cases, excepting those mentioned by Packard and Watson, shows two classes of examples: the one occasioned by falls or blows upon the chin, and producing a simple fracture of the neck of the condyle; the other occasioned by injuries inflicted upon the side of the face, and producing a fracture of the neck on the side corresponding to that upon which the injuries are received, and at the same time a fracture of the body upon the opposite side. These two varieties seem to be about equally common. In Houzelot's case there existed also a fracture of both condyles, of both coronoid processes, and at the symphysis. In Watson's case the face was some- what deformed by the retraction of the chin; the mouth could not be opened so as to protrude the tongue to any great extent beyond the teeth, and the teeth of the upper and lower jaws could not be brought into contact. In attempting to move the jaw, the patient experienced pain and crepitation just in front of the ears; the crepitation could easily be felt by placing the fingers over the 1 Smith, New York Journ. Med., Jan. 1857, Hospital Reports. 2 Practical Treatise on Fractures. By Edward F. Lonsdale, London, 1838, p. 226. 3 Institutes and Practice of Surgery. By William Gibson. Philada., 1841, p. 261. 4 Trans. Amer. Med. Assoc, vol. viii. p. 385. Report on Deformities after Fractures, Case 17. 5 Malgaigne, op. cit.. p. 337, from Ledran, Observ. Chirurg., torn. i. obs. vii. 6 Smith, New York Journ. of Med., Jan. 1857. Bellevue Hosp. Reports. 7 Malgaigne, op. cit., ]). 400.](https://iiif.wellcomecollection.org/image/b21056699_0106.jp2/full/800%2C/0/default.jpg)
