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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    but Is not separated from the outer surface of the splinters. The whole.of the Boft parts sm-rounding the bone suffer a not inconsiderable crushing, as they nre enclosed between the skin [and fascia] and the spreading portions of bone, and to this crushing of the soft parts I think we must refer many of the symp- toms immediately consequent on gun-shot wounds. If a lower limb is struck Rt the moment when the weight of the body bears upon it, the injury will be much more extensive, for the upper fragment is thrust down by the whole weight of the body into the soft parts, the splinters separated, and fi'om many of them the periosteum torn off. Those splinters which have lost all connection with the periosteum, lose their vitality, and, acting as foreign bodies, nmst be removed sooner or later. Occasionally the splinters are yet • firmly united to the muscles by the ten- dons, and much time must elapse before they become loose. Not unfrequently those entirely separated at the time have been simultaneously driven into the medullary canal, or remaining between the broken ends, they hinder the complete closure of the wound ; in favourable cases, such splinters may be- come encysted, as bullets or other foreign bodies may be,—usually, however, they excite fresh inflammation and formation of matter, and if not removed at the right time, cause so much annoyance to the patient, that he frequently wishes that the limb had been rather amputated. An operation for necrosis is frequently now beneficial, I conceive that the tertiary splinters of which Dupuytren speaks are to be referred in many cases to these primary ' fracture-splinters' incarcerated by callus. Although I do not deny that the contused ends of fi-agments in gun- shot wounds often become necrosed, yet experience has taught us that it is not so common of occurrence under favorable circumstances and with suitable treatment as has been expected, and the removal by the saw of the fractured ends is to be entirely given up, unless necessitated by peculiar circumstances; as, when nerves are irritated by sharp points of bone. The necrosis occurring after comminution of the shaft, is not a consequence of the concussion, but of inflammation of the bone with suppuration, healthy or unhealthy, this may equally well arise upon a flat sawn surface as upon the surface of the fracture immediately caused by the bullet. Similar principles hold good with respect to the fissures occurring very often in comminution of long bones, and extending themselves frequently upwards and downwards for a great distance. The older surgeons have considered these fissures as very dangerous, and they are so, if the suppuration becomes foul and the bone inflames. In such cases the suppurative action follows the course of the fissures and extensive necrosis is the result, unless the patient is carried off by the phlebitis in the bone common in such cases. Under favo- rable circumstances, however, these fissures heal just as well as fractures, by means of effused callus, which shortly removes every trace of injury. Fissures of bone may equally well arise in simple contusions or injuries, in which no actual fracture is present. If the fissures extend into the joint, the injury is of course much more dan- gerous. The study of the preparations, however, collected by Stromeyer, in the campaign, evidences a most important practical point, that in comminu- tion of the shaft of a long bone, the fissures almost never extend into the epiphyses ; in the same manner injuries of the epiphysis only, in extremely