A new operation for ununited fracture of the tibia / by Wm.H. Pancoast.

  • Pancoast, William Henry, 1834-1897.
Date:
1877
Catalogue details

Licence: Public Domain Mark

Credit: A new operation for ununited fracture of the tibia / by Wm.H. Pancoast. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    Oa examining the leg, I found that the fracture had taken place, just below where the nutritious artery enters the bone, and had thus cut off the supply of arterial blood necessary for the proper effusion of plasma to make callus ; this, I pre- sumed to be one of the reasons of the formation of the false joint. The main cause, however, appeared to me to be, that the fibula, which had remained unbroken, acted as a splint to the broken tibia. It being fastened by its ligaments, above, to the head of the tibia, and to its lower end, where the external and internal malleoli project downwards, making the socket for the astragalus, forming the ankle- joint. The last operation of resection only increased the difficulty, as the upper and lower fragments, being fastened to the fibula, were kept asunder the distance of three inches. At my next visit, the patient repeated her earnest request for an amputation. I answered her by saying that she had broken the tibia by a fall, and if she would tumble so as to break the fibula, I thought I could cure her. This she said she could not do, but she was willing that I should do any- thing I thought best for her. I asked her if she would permit me to break the bone. She said most cheerfully. On my next clinic day, having prepared her for the operation, I took her before my class. I described the case as above mentioned, stating that as the fibula acted as a splint, keep- ing the fragments apart, I proposed breaking it subcuta- neously. Then forcing the lower fragments of both bones upwards, so that they would overlap the upper, I hoped that the fragments, thus approximated, would under the stimulus of the inflammation become united by callus. I etherized the patient, and then with a strong gimlet, pierced the integument on the outside of the leg, and screwed it into the fibula, about three inches above the external malleolus, where this bone is still superficial. I withdrew the gimlet from the bone, but not from the integument, and slipping the point a little further ujiwards, I bored a second and a third hole in the same way. The fibula is narrow and does not give you much surface to work on, requiring for
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