Surgery : its theory and practice / by William Johnson Walsham.

  • William Walsham
Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: Surgery : its theory and practice / by William Johnson Walsham. Source: Wellcome Collection.

    174/864 page 158
    Varieties of fracture.—A fracture is said to be simph wlien the skin covering it is not broken; compound wLon a woimcl througli the skin and soft parts leads down to the seat of the fracture. Whether simple or compound, fractures are further spoken of:—1. According to their extent, as:—complete, Avhen the bone is broken quite across ; incomplete, or greenstick, when partially broken and partialh' bent; comminuted, when broken into several pieces ; txnd multiple, when two or move distinct fractiu'es occur in the same bone, or in different bones. 2. According to the condition of the fragments, as :—imjMcfed, when one fragment is driven into another: fissured, when there is a mere crack through the bone without displacement; depressed, when one fragment is pressed in below the surface, as in some fractures of the cranium ; punctured, when there is a small perforation with driving inwards of the fragments : and splintered, when only a fragment of bone is chipped off. 3. According to the line of fracture, as:—transverse, ohlique, spiral, longitudinal, or stellatf, terms which sufficiently explain themselves. A fracture, moreover, is said to be complicated, when associated with other injuries, as rujiture of the main artery of the limb, implication of a large joint, &c. Displacement of the fragments, es])ecially in the bones of the limbs, commonly occurs, except the fracture is trans- verse, when, as in the case'of the tibia, there may be little or none. The causes of the dis]ilacement may bo (uitunerated as : 1. The weight of the limb acting on the lower fragment; 2. ISIuseular contraction ; and o. The violence producing the fracture. The amount of dis- placement will depend in part on the direction of the line of fracture, and in part on whcthei- the periosteum is or is not torn. Thus the displacement is usually considerable w]\en the fractiu'o is oblique, insignificant when trans- verse, es])ccially if the periosteum is intact. The dis- placement is spoken of as angular, latend. longitudinal. and rotatory, according to the direction wliicli the frag- ments bear to each other. ,S)V/)i.s.—P,efore examining for fracture, the clothos should be carefully removed, and the parts handled tenderly-, lest a sim])le frai'ture be converted into a com- poiuul by a sharp fragment being driv(>n thror.gh the skin. Tims, in tlie c;isc of the h'g. the boot sli.add bo cut (iff, the trousers rii)])ed up tho.«eam. and the stocking split witli scissors. 'I'lic injured side shoidd always be
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