On the fractures of bones occurring in gun-shot injuries / by Louis Stromeyer.

  • Louis Stromeyer
Date:
1860
Catalogue details

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 at the same time forming extensive sinuses in the arm and forearm. In a case where the real nature of the disease was overlooked during five weeks, ab- scesses had formed in the lungs, pus was expectorated, and the patient was hectic in a high degree. This case proved fatal by the advance of the pul- monary disease. Li all cases where recognising an injury to bone in the elbow-joint, I never hesitated in recommending resection as a rule. The joint was opened poste- riorly, with preservation of the ulnar nerve, by making a longitudinal incision in the course of the nerve [on its outer side], upon this fell a second one, per- pendicular to the first, entering the joint between the outer condyle and head of the radius, proceeding over the olecranon, yet dividing the triceps tendon,—■ RO that by this second incision the joint was opened. After that, with constant preservation of the ulnar nerve, the ligaments of the joint were fuUy divided posteriorly, so that it gaped freely, the loose fragments were extracted, and those still attached removed by the knife or by Cooper's scissors. Had the ulna alone been shattered, the corresponding portion of the radius was re- moved, yet never more than the head of this bone, or perhaps also the neck, even when the ulna had been comminuted. Indeed it never happened that the whole continuity of the ulna was destroyed to a greater extent downwards than the neck of the radius, at least a portion projecting thus far. So that by division of the bone at this spot, transversley by the saw, it was attempted as much as possible to preserve the bones of the forearm of the same length. Had the ulna been divided at the commencement of uninjured bone and a corresponding piece of the radius removed, in many cases three or more inches in length would have been lost, the operation 'would have become very diflicult and severe, and the consequences probably much worse, as neither a new joint nor anchylosis would have resulted, if indeed the patient had escaped with preservation of his life or his limb. I have never had occasion to repent this sparing method of treatment, but, on the contrary, have assured myself that new formation of bone occurs from the preserved portion of the ulna, whereby it reacquires its usual volume. If the radius was comminuted below the neck, the fragments were extracted and the uneven projections removed by the saw; the uhia was not sawn off at the same level, but merely a piece removed from the olecranon, as otherwise this protruded in a troublesome manner during and after the healing. As on the ulna depends especially the strength of the elbow-joint, it is not necessary to saw this off so deeply, as the radius. After the ulna and radius had been freed of their fragments and rendered even by the saw, a portion alone of the trochlea humeri Avas savra off, if but little of the ulna had been removed. In many cases the humerus was untouched or merely the cartilage shaved off by the knife,—this last procedure seemed to have no influence towards a more rapid recovery, as Zeis has expressed his opinion that it might. Had the injury of the humeras involved the elbow-joint, similar methods were adopted, as with the radius and ulna. Generally one or other condyle was shattered and the Assuring proceeded above the capside,— resection at tlie cessation of the fissures would have necessitated a loss of sub- stance of from two to two and a half inches. The humerus was therefore sawn off, after the removal of fragments, at the place where the fissures had nearly terminated, and by this means an inch in its length was frequently preserved. In these cases, if the bones of tlie forearm were uninjured, a piece was stiU