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.
74/858 page 80
![Fig. 26. Dieffenbach's drill for ununited fracture. In case the seton cannot be passed directly between the opposing fragments, as recommended by Physick, we may adopt the practice suggested by Oppen- heim, and carry two setons, one on each side, close to the bone. Somme, of Antwerp, preferred a loop of wire to the silk seton employed by Physick.1 Seerig passed a liga- ture around the ligamentous mass connecting the two fragments, and then proceeded to tighten the ligature until it fell off.2 Dr. Hulse, of the U. S. Navy, em- ployed stimulating injections with success in a case of non-union, accompanied with an external and fistulous opening.^ In 1848, Dieffenbach recommended that ivory peg's be introduced into holes previously made in the bone4 by means of a gimlet or drill, and Mr. Stanley has succeeded once by this method.5 Mr. Hill intro- duced the ivory pegs in a case of ununited fracture of the femur, pyaemia supervened, and the patient died.6 Malgaigne, in 1837, tried to introduce acupuncture needles between the ends of an ununited fracture, but, although he thrust the needle down to the bone thirty- six times, he was unable to make it pass once between the ends of the fragments. Wiesel succeeded better. In a case of ununited fracture of the ulna, of nine weeks' standing, having passed two needles between the fragments, at the end of six days, the needles being removed, consolidation rapidly ensued.7 This practice does not differ essentially from the metallic hoop of Somme. It is only a modification of the seton. Brainard, of Chicago, has attempted to show that setons of any kind, whether of wood, ivory, or metal, placed in contact with the bone, occasion absorption, caries, and necrosis, but that they never directly give rise to bony callus; and that the occasional success of the seton, which success he believes to have been greatly exaggerated, has not resulted from any tendency to favor the formation of callus, but from the induration and tenderness of the soft parts produced by it; circumstances which, by conducing to rest, indirectly favor the consolida- tion.8 [The seton, as a remedy for non-union of bones, has been superseded by anti- septic operations of far greater certainty in securing union, and free from danger. The most important of these operations is the wiring of the fragments.] In May, 1848, Miller, of Edinburgh, reported five cases treated successfully by subcutaneous puncture. The operation consisted in passing the point of a needle or small tenotomy bistoury down upon the ends of the bone, and freely irritating the surfaces at several points.9 George F. Sandford, of Davenport, Iowa, has successfully imitated this practice in two cases.10 In 1850 Dr. William Detmold, of New York, performed the operation of drilling or perforating the fragments in a case of ununited fracture of the tibia, employing for this purpose a large gimlet. He first bored two holes between the opposing fragments, and then, introducing the gimlet one and a half inch below the fracture, he penetrated the tibia upward and inward until he had traversed, also, the upper fragment to the extent of an inch. In three weeks the bone appeared firm, but from this time the patient was not seen.11 1 Amer. Journ. Med. Sci., vol. vii. p. 497. 2 Norris, loe. eit., p. 46. '■> Hulse, Amer. Journ. Med Sci., vol. xiii. p. 374. 4 Malgaigne, trans, by Packard, op. cit., p. 258, note. 5 Stanley, New York Journ. Med., Nov. 1854, p. 441, from Dublin Press. 6 New York Med. Gaz., July 4, 1868, from tbe London Lancet. 7 Wiesel, Amer. Journ. Med. Sci., vol. xxxiv. p. 254, July, 1844. 8 Brainard, Trans. Amer. Med. Assoc, vol. vii., 1854; Prize Essay. Report on Surgery to Illinois State Med. Soc, May, 1860. 9 Miller, New York Journ. Med., July, 1848, p. 134. 10 Sandford, Trans. Amer. Med. Assoc, vol. iii. p. 355, 1850. ii New York Med. Gazette, Oct. 12, 1850.](https://iiif.wellcomecollection.org/image/b21056699_0074.jp2/full/800%2C/0/default.jpg)
