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.

    182/864 page 166
    joint may resemble a hinge ov a ■ball-ancl-sockot joint. The latter condition is more common in fractures near the articular ends of bone where rotatory as well as angular movement may occur; the former m the shaft where augTilar movement onlv is permitted. The Causes are local and constitutional. The had are — 1, The fra^•ments not having been kept thoroughly at rest; 2, The'fragments not having been i)laced m apposi- tion in consequence of (a) muscular contraction ; {I) the loss of a large piece of bone, as in compound fracture; (c) the intervention of a piece of muscle, tendon, or_ peri- osteum between the fragments ; and (c?) the eftusion ot synovial fluid in the case of a fracture into a joint; ■3 The necrosis of the end of one of the fi-agments; 4' The interference with the arterial supply of one of the fra°'ments, as from injurv of the medullary artery; and 5, The poor supply of'blood to one of the fragments, as m fracture of the anatomical neck of the humerus. _ Constitutional causes.S^-phUis, struma, gout, Bright s disease, fever, sciu'vy, the cancerous cachexia, pregnancy, old age, alteration of the patient's habits, and sudden deprivation of stimulants, are all said to be causes ot ununited fracture. No doubt any condition that lowers the vitality and consequent power of repair of the tissues has a tendency to delay union, but it seems doubtful if any of the above conditions except scuiTy is in itself, apart from the local causes, sufficient to prevent the bone uniting. , . , ^ j Sometimes the callus, after having becn_ formed, appears to bo re-absorbed, the fracture being then spoken of as disunited. This appears to be not imcommon IWme»^.-Constitutional as well as local treatment may be recpurcd. In recent cases-/ .., where the fracture h found uiunited after having been ke]. in sphnts for the usual time, a condition sometimes called dchn/<_dvnH.n in CO ti KbSinction to ununited fracture, the splints shoiild be re-apTli.Ml, and in such a manner as to ensure ],erfect mmobility-f the fragments; whilst .the general health «liould bc in.provod by every means m our po^ er and any constilnt'nnal taint as sy],h,hs, gout, .V-c., that n ay L detected, combated by appropriate remedies If the patient has been accustomed to stimu ants, and has been prived of them, he should be allowed a moderate q an itv. In some cases it may be expedient to put the
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