Clinical lectures on surgery / by M. Nélaton ; from notes taken by Walter F. Atlee.

  • Nélaton, Auguste, 1807-1873.
Date:
1855
Catalogue details

Licence: Public Domain Mark

Credit: Clinical lectures on surgery / by M. Nélaton ; from notes taken by Walter F. Atlee. 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.

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    had been one of abduction, or of divulsion, as M. Nekton prefers to call it, and the displacement was extreme. In order that this fracture can take place, a rupture of the internal lateral ligament is necessary, and the astragalus had followed the external malleo- lus, so that its internal face was nearly one inch from the internal malleolus. The axis of the ]eg, prolonged beyond the lower ex- tremity of the tibia, instead of falling upon the middle of the foot, fell upon its inner border. The whole foot had undergone a movement of rotation, the heel being carried inward, the point outward. There was, a depression on the external side of the leg, about two inches above the extremity of the malleolus, indicating the seat of fracture in the fibula. Sir Astley Cooper has noticed, many times, the tearing off of a portion of the tibia, about an inch in size, of the part next to the ankle-joint, where it is so firmly attached to the fibula. In this case, M. ISTelaton supposed that it had taken place on account of the very great displacement that existed. This patient was unable to walk. If tired of remaining in bed, she would attempt it; the integuments would be irritated and ulcerate; and it might happen, that even without walking, after a length of time, an opening would form upon the internal ankle. Beside the dangers resulting from this, the patient would suffer cruelly from the tearing of the ligaments. All this was sufficient to lead to the intervention of art for the relief of the deformity. The reduction of the fragments, the seton, an angular resection, the rupture of the callus, the section of the bone, and the amputa- tion of the limb, are employed in these cases. As to the latter, amputations par complaisance^ are very gene- rally abandoned. When the plan of reducing the fragments is chosen, it can only be in cases where the callus is still soft. Du- puytren was the great partisan of this method. The time in which it can be done, is from the tvrentieth to the sixtieth day, at furthest; here, four months and nine days had elapsed, and, at that period, M. Nelaton despaired of being able to effect anything by simply stretching out the limb. The seton is employed by some surgeons. By means of a per- forating instrument, a hole is made in the callus, and a seton is introduced and left there, Infl.ammation is excited, the callus is softened, and, after that, the fragments can be brought into post-