On the occurrence of non-union after fractures : its causes and treatment / by George W. Norris.

  • Norris, George W. (George Washington), 1808-1875.
Date:
[1842]
Catalogue details

Licence: Public Domain Mark

Credit: On the occurrence of non-union after fractures : its causes and treatment / by George W. Norris. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    compound fractures, must have been noticed by all surgeons, and the good effect produced in such cases by an increased diet, and the allowance of an accustomed stimulus, as well in causing the more rapid deposit of callus, as in improving the state of the wound, have been observed. That the large abstraction of blood alone will not prevent the formation of callus is well seen in the following cases. Isaac Yorke, aetat. 19, was admitted into the Pennsylvania Hospital, October 5th, 1801, for fracture of the right thigh. His accident had happened one week previously to his admission, during which time he had been delirious, and had undergone five bleedings, in all amounting to one hundred and two ounces. He continued to do well until the 7th, when his delirium returned, and between this date and the 15th, he was bled at different times to the amount of ninety ounces, making in all one hundred and ninety-two ounces; from the 15th he recovered rapidly, and was discharged from the hospital January 13th, 1802. Jas. Orr, aetat. 32, was admitted May 16th, 1804, for compound fracture of the leg two inches above the ankle, and injury of his thorax. Great pain and difficulty of breathing followed the accident, to relieve which he lost thirty ounces of blood in the first twenty-four hours following it. On the 20th, delirium set in, and in the two following days sixty-two ounces more of blood were taken from him, making in all ninety ounces; after this his symptoms abated, and he recovered rapidly. (Penn. Hosp. Case Book, i, pp. 27, 31.) The influence of the nervous system over the processes of reparation in the body is well known, and that want of nervous influence might alone be sufficient to prevent consolidation after fracture from occurring, have been supposed. That it may be a sufficient cause there can be no doubt; an instance is mentioned by Mr. Travers, (Further Inquiry, &c. p. 436,) in which union failed to proceed after a fracture of the leg that was paralysed from fracture of the lumbar vertebrae, although the humerus, broken at the same time, united perfectly in the usual period. Mr. Tuson notices a case of paralysis of the lower part of the body from injury of the spine, accompanied by fracture of the fibula and dislocation of the shoulder joint, in which the fracture of the fibula, the leg being paralysed, did not reunite, nor did there appear any reaction about the parts to effect it; whilst the capsular ligament of the shoulder joint, which was not paralysed, did unite and was scarcely perceptible. (On the Spine, p. 254.) Mr. Benjamin Phillips (Lond. Med. Gaz. for May 1840, p. 327) has seen a case in which the same injury that fractured a man's leg injured the lower part of the spine; he lived five weeks, but there had been no effort at reparation. Diminished nervous influence will not, however, in all instances, hinder the formation of callus, as is shown by a case recorded by Mr. Busk, (Lend. Med. Gaz. for April 1840, p. 97,) of a gentleman, actat. 65, who had been more or less paralytic for upwards of twenty years, for the last twelve or fourteen of