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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![m the upper third of the tibia. As the soft parts in this species of cases aro at the same time much injm-ed, severe inflammatory symptoms follow, theso cases are often however favorable, as I have twice observed in the tibia, which bad beeu pierced from before backwards by a bullet. 6. The, bidlet bruises the bone with or without sensible depression, or becomes peated in or traverses it, at the same time however gives rise to fissures into the the next articulation. I have observed this case most frequently in the elbow- and knee-joint, in the last named both in the femm' and tibia. The diagnosis here is extremely difficidt, indeed in many cases it cannot be formed with cer- tainty, as the fissm'es in question are so fine, that they may neither be felt by the finger nor by a probe. In the first instance the motion of the joint is perfect, it is when the suppuration from the wound becomes considerable that the joint inflames and likewise ])roceeds to suppuration in spite of aU antiphlogistic means. After the battle of Colding we had in Christiansfelde four such impli- cations of the knee-joint, in which it was doubtful for many weeks whether the b'mb could bo saved, or not. In tliree of these cases amputation became neces- sary, and in each fissures into the joint were discovered in the removed limb. In the foiu-th the limb was preserved, and here doubtless the fissuring had not taken place. But one case is come before me, where the tibia being struck on its posterior surface close above the ancle-joint and the fibula being grazed, fissures extending to the joint were indicated, as it became much swollen and was the seat of very severe pain, A cure nevertheless ensued with anchylosis, and to this certainly the use of ice, and internally of laige doses of Opium much contributed. 7. The bullet strikes a long bone at a right angle in its shaft and forces its way through it, breaking the part into many pieces, the fissures passing more or less upwards and downwards according to the long axis, for a con- siderable distance from the affected spot. This happened most frequently in the tibia, but as the fibula often remains uninjured, the dangerous con- dition is not readily known, here also the fissures not being recognisable. The loose splinters are removed and it is hoped ihat under suitable treat- ment the limb may be preserved; in spite of this, however, a widely diffused inflammation sets in, proceeds to suppuration and continually extends itself unchecked by incisions. In certain cases a cure follows after exfoliation of extensive secondary and tertiary sequestra,—in others amputation becomes necessary from the extensive suppuration, or from parenchymatous bleeding, still under such circumstances, the life is rarely preserved. The parenchymatous heemorrhages are, as 1 have found, and will elsewhere prove by facts, at once a symptom of the entrance of pus into the veins, and of stoppage of the larger veins by coagulation. The stagnation of blood t'lereby ensuing, gives ri^o to ha)morrhage from the capillary vessels lying free in the wound and on this accjuntj the blood so lost has neither a de- cidedly venous nor arterial character. Nevertheless I will not assert that parenchymatous hajmorrhages—independent of stagnation in the veins and similar to scorbutic bleedings—are not met with from the surface of wounds. On the Examination of Gan-shot Wounds, the Bone being injured. It may be believed that nothing is more easy to diagnose than an injury of bone, with a wound extending to it which offers no hindrance to the introduc- tion of the finger. Indeed one might think that these fractures must be much](https://iiif.wellcomecollection.org/image/b21079432_0020.jp2/full/800%2C/0/default.jpg)
