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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![Gradually, however, becoming worse, the pain and also the suppurative discharge increased. On a more careful examination the joint was found involved. Dr. Langenbeck now, the 10th May, performed resection, with preservation of the tendon of the biceps. The bullet had traversed the humerus, close below the joint, and fissured it freely upwards and downwards, so that 4j inches of bone required removal by the saw. A small semicircular piece had been struck out from the glenoid fossa, and was forced against the lower surface of the scapula, which was evidently grazed and splintered, as matter formed here at a later period, and with it were dischaxged sequestra and pieces of clothes. Healing took place favorably, and the patient could go out by the end of July. On August 28tb, the wound was closed, excepting a small fistula, which led to behind the scapula. At this time a more careful examination showed that the resected portion of bone was replaced by a fibrous mass, which felt tolerably firm, and bound the upper end of the humerus with the glenoid cavity ; as this sub- stance at a later period gradually hardened, its partial ossification was to be expected. The active mobility allowed the nose to be taken hold of by the fingers of the left hand. After the wound was fully healed, passive motion was regularly employed and the patient m-ged to make use of the limb. In the beginning of 1850, the upper end of the humerus had regenerated itself so much, that the resected arm was only one inch shorter than the other. It could be moved by the patient in all dii'ections, and a chair could easily be lifted by it from the ground. The arm was as well nourished [robust] as the sound one, but the roundness of the shoulder was wanting, and it appeared as a luxation into the axilla. Also on each movement, the arm escaped some- what from the glenoid cavity, backwards or forwards, partly from the liga- ments being looser, and partly from the biceps tendon having lost its groove in the head of the humerus. In the summer, 1850, the bullet came to the siu'face, and was cut out. Case X.—Grazing of the Os Humeri, and Commimition of the Spina Scapulas. Resection on the 4th day. Hsemorrhage, Pyajmia, Death.— The Schleswig-Holstein foot soldier, B , was shot in the left shoulder, at Fridericia, July 6th, 1849. He was brought to Hadersleben at once. July 10th, the arm and shoulder were greatly swollen and painful, and serous, thin pus flowed copiously from the wound. The bullet had entered at the posterior and outer border of the shoulder, an inch below the acromion; on examination, the finger reached the joint, and felt the os humeri bared on its posterior aspect; some splinters lay in the shot-track, the bullet could not be discovered. Dr. Goetze at once performed resection after Langenbeck's method; on bringing the head of the humerus out of the wound, it was seen that the bullet had grooved it posteriorly and also its anatomical neck, for an inch and a-half, the groove being three-quarters of an iiach wide and one quar- ter of an inch deep. An inch and a-half was removed fi'om the humerus, and the arm returned to its position. Pissures of the scapula were perceptible on examination, especially about the superior notch. Some loose splinters were removed, the bullet was not discovered. At first proceeding well, the patient later became feverish, and, July 17th, hsemorrhage occurred about midday, after the wound had been dressed. Six ounces of blood were lost. As the source of this bleeding could not be seen, the v>'ound was dilated,](https://iiif.wellcomecollection.org/image/b21079432_0085.jp2/full/800%2C/0/default.jpg)
