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.)

    4/55
    Mr. Howship. The opinion arrived at by this gentleman after the perform- ance of a number of experiments, is, that the blood effused immediately after the occurrence of a fracture, becomes the medium in which the ossific process is first established. According to him, the periosteum assumes by degrees the characters of cartilage, and the bony matter is deposited succes- sively upon the surfaces of the fractured fragments, the circumference of their extremities, and within the medullary cavity. Later investigations of the French physiologists and surgeons have however clearly shown, that the process of union is not exactly effected in any of these ways, and their views, which are founded upon numerous experiments upon the inferior animals, as well as upon autopsic examinations in all stages of fracture, are those now generally adopted. According to the French, two distinct epochs may be distinguished in the formation of callus, or lather there are two calluses successively formed. The first, termed the provisional callus, is produced ordinarily in the space of thirty or forty days by the reunion and ossification of the periosteum, the cellular texture, sometimes of the neigh- bouring muscles, and in the long bones, by the ossification of the medullary tissue. The second, called definitive callus, is formed by the immediate agglutination of the two broken ends themselves, and is never completely finished before eight months or a year, by which time the provisional callus, that is gradually absorbed, has disappeared. The provisional callus surrounding the fractured fragments, though in larger quantity, is of a less solid nature than that which is definitively formed. The definitive callus when complete, though less voluminous, offers so great a resistance that the bone may be fractured more easily at any other point than that at which it was previously injured. The progress of consolidation after fractures may be divided into five periods, each characterized by distinct phenomena. (Breschet, Richer dies sur la Formation du Cal. Paris, 1819.) The first period extends from the time of fracture to the 8th or 10th day, and presents the following appearances. The blood poured out by the ruptured vessels of the bone, periosteum, medullary membrane, medulla, and the surrounding cellular tissue, coagulates in all the surrounding parts, as well as in the medullary canal. Slight inflammation then follows, the cellular tissue, and the parts adjacent, becoming infiltrated with a gelatinous lymph. In the interior of the bone, the medulla and its membrane likewise become inflamed, and pour out the same substance around and between the broken surfaces, and this effusion produces some thickening about the fracture, which in consequence becomes less movable. The extravasated blood is in a short time altogether, or in part absorbed: it in no case contributes to the reunion of the fracture, and when in large quantity, rather retards the process. By the end of the period mentioned, (10th day,) the ends of the fractured bone are surrounded either by a viscid substance, or by a homo- geneous tissue of a reddish colour and spongy consistence, produced by the general engorgement and infiltration of the soft parts.