On the fractures of bones occurring in gun-shot injuries / by Louis Stromeyer.
- Louis Stromeyer
- Date:
- 1860
Licence: Public Domain Mark
Credit: On the fractures of bones occurring in gun-shot injuries / by Louis Stromeyer. 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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![tlie body of the bone in two, and the pieces then extracted by the forceps described.—a pair of a similar kind has been made for me bv ]NIr. Weedon, of Hart Street. These forceps cannot be too much recommended for opera- tions on the larger bones. On examination there was a white deposit transTersely beneath the joint- surface of the bone of about a quarter of an inch in diameter, with some adhesion from about this point to the tibia. The inner side of the astralasrus was diseased. Slight bilious fever occurred, but was quickly remored ; the wound granu- lated healthily, and was nearly filled in a fortnight. It is worthy of notice that the discharge for some days was watery with flakes, this, no doubt, was the cartilaginous substance. However, a fistula remained, and, on November 21st, it was determined to remove the malleoh. This was done fi'om the inner side alone, hence up till tliis time there have been fistulte on both sides, with occasional discharge of sequestra. I had wislifid to remove about an inch fi-om the bones of the leg at the the time of the ]£st operation, but was otherwise advised. Ic had been recommended to me in the first instance. Of the tiltimate recovery I do not doubt, and the present (March 21st^, state of his joint appears as if no further operation would be required. These good results nrom the operation of resection, ^iz.; in a patient, with organic disease, of 7-1 years of age, after the elbow had been excised; in another, of 20 rears of age, after resection of the knee, when the joint was in very bad condition, and two cases of diseased ancle—being soimdly healed, while the two last cases remain iu a doubtful condition, merely because an insufficient quantity of bone was removed, justify me in preferru^g resection of a whole bone to a pai'tial gouging of it. I have had no other operations of resection of joints. Mr. SoUy has spoken of Kesection of the Asrralagus, that it ''sounds well and reads well, and, appiu'cntly, would infer that such might be the object of the operation. However, I must add, that they, also, ••' get weU,' which is more than can be said of very numerous cases of gouging of bone. Of course, there is no very extensive disease if, only a slight fistula remains and the patient goes into the country. For my pari:, I prefer keeping the patient under observation until deep, firm scars, no pain, and no discharge, givo positive testimony that the patient is cured. In performing the operation, the main points are—to ensure there being no haemorrhage, that would require ligatures being applied.—to divide no tendons or nei^es passing over the joint, to make the flaps in such a way that they will lie naturally in place after the operation without any sutm-es, and never (Stromeyer) to remove the limb ftom the splint during the progress cf cure. Xo matter how large the wound is, it appears, under this method of ope- rating, to be nearly filled up -nith granulations in 10 or 14 days; but one most important adjuvant remains to be considered:—that, as antiplilogistic treatment is the best possible preparative for the winding-shroud in all ex- tensive operations,—the patients shorJd be fed just as well after the operation as before, and that frequently, they require stimulants to prepare them for the operation, if so, these should be c'oLtinued after the same.](https://iiif.wellcomecollection.org/image/b21079432_0135.jp2/full/800%2C/0/default.jpg)
