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.
76/858 page 82
![steel shaft with a handle, a silver sheath, and a brass nut. For a broken femur the shaft is six inches long, its lower extremity being constructed like a gimlet, while two and a half inches of its upper extremity are cut for a male screw, being intended to carry the brass nut. The sheath is three inches long. Through an incision made over the seat of fracture, the sheath, detached from the shaft, is carried down to the bone. The shaft is then passed through the sheath, and made to penetrate and transfix the two fragments; as soon as this is accomplished, the nut is turned down firmly upon the top of the sheath, and apposition of the fragments is thus secured. The whole instrument is permitted to remain until bony union is effected.1 Fitzgerald, of Melbourne, has practised successfully the injection of five to ten Fig. 28. Gaillard's instrument for ununited fractures. minims of glacial acetic acid between the fragments. It causes at first a sharp pain, and he thinks it accomplishes its beneficial results by causing a resolution and absorption of the interposed fibrinous, cartilaginous materials and encour- aging the substitution of bone.2 Finally, having thus brought rapidly before us all of the various modes of treatment which have been suggested and practised for non- union of broken bones, wre are prepared to affirm the following conclu- sions, or summary of what has been our own practice, and of what we believe ought to be the general course of procedure in these cases: 1. Improve the condition of the general system. 2. Remove as far as possible the local impediments, such as a separa- tion of the fragments, local paralysis, local scurvy resulting from long exclusion from light and air, congestions, etc. 3. Increase the action of the tissues immediately adjacent to the fracture, upon which tissues, rather than upon the bone, the formation of callus depends. This may be accomplished by frictions, and violent flexions of the limb at the seat of fracture: possibly in some measure by the application of vesicants or of other stimulants to the skin itself. 4. Employ again compression and rest for a period of from two to four or eight weeks. 5. Resort to the method recommended by Brainard, or to some of its modifications, to interfragmentary injections, etc. 6. If in the lower extremity, allow the patient to walk about with the fragments well supported. [7. If simple measures fail, resort to the operation of wiring the frag- ments, with antiseptic precautions.] Where these measures have failed, after a fair trial, we should cease to hope for success from operative measures, and subsequently rely only 1 E. S. Gaillard, New York Journ. Med., Nov. 1865. 2 Boston Med. and Surg. Journ., Aug. 15, 1878, from Medical Press and Circular.](https://iiif.wellcomecollection.org/image/b21056699_0076.jp2/full/800%2C/0/default.jpg)
