Injuries of joints / by Robert Jones.

  • Robert Jones
Date:
1915
Catalogue details

Licence: In copyright

Credit: Injuries of joints / by Robert Jones. Source: Wellcome Collection.

    43/200 page 39
    fore permits of forcible readjustment of the position of the fragments of bone ; this corresponds to the tender vascular stage in the cicatrization of soft parts. So, just as tearing the soft cicatrix means more effusion and excessive cicatricial tissue, the necessity forcibly to twist or readjust callus after it has begun to form carries with it the penalty that the increase of exudate may result in excessive formation of bony callus. Small displaced fragments should not be left where they will obstruct the movement of the joint. The ideal treatment is to get them back into their place. A common example where this can be done is found in the fracture of the anterior edge of the lower articular surface of the tibia, which often occurs in association with Pott's fracture of the fibula. All that is here needed is to dorsiflex the foot when setting the fracture ; the surgeon then pushes the wedge- shaped piece of bone back into position, where it is held by keeping the foot dorsiflexed. At the elbow fragments of bone blocking full flexion will usually be pushed aside when putting the joint into full flexion. If the fragment will not get out of the way, there should be no hesitation about read¬ justing or removing it by operation. The formation of excessive callus, i. e. excessive osseous formation in the exudates of blood and lymph about the seat of injury, may be determined by the violence of the original injury, which of course is beyond the surgeon’s control, but is often due to un¬ necessary irritation of exudate at a later stage by im¬ perfect fixation, by allowing injudicious movements,
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