Compound and comminuted gun-shot fractures of the thigh and means for their transportations, etc / John Swinburne.

  • Swinburne, John, 1820-1889.
Date:
1864
Catalogue details

Licence: Public Domain Mark

Credit: Compound and comminuted gun-shot fractures of the thigh and means for their transportations, etc / John Swinburne. 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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    I give here the character of injury which requires amputation: 1st. Cases where the artery or arteries are destroyed or so lacerated as to cut off circulation below the wound, where circu- lation ceases and gangrene is the inevitable result. 2d. In cases where a limb is torn nearly or quite off, as with a solid shot or any other analogous missile, leaving an irregular or ragged stump. 3d. Cases of extensive injury to the soft parts alone, where gangrene would be likely to follow from the loss of the principal nerves or arteries. 4th. Cases of compound and comminuted fracture of the knee and ankle joints require amputation, while the passage of small balls which do not shatter or open the joint do not necessitate amputation, and particularly is this true of the ankle-joint. Com- pound and comminuted fracture of the femur or tibia which extend into the knee joint require amputation. Rules for Excision of Joints and Simple Fracture of the Shaft of the Long Bones. 1st. Excision should be confined to the upper extremities—the shoulder and elbow being the principal parts upon which that operation should be practiced. 2d. If the head of the humerus is shattered by a gunshot, exci- sion is the only remedy. If the comminution extends to the shaft, the loose portions only which are deprived of periosteum need be removed—the residue left to granulate. If the glenoid cavity is crushed, its loose spiculse can be removed or its injured portion gouged out. 3d. If the elbow-joint is crushed or comminuted by a ball, exci- sion is the only remedy. If the injury is confined to the articu- lating end of the humerus, remove it, but do not disturb the ends of the radius or ulna; on the contrary, if the injury be confined to the articulating ends of the radius or radius and ulna, remove both, but not the humeral articulation. If the articulating ends of the humerus, radius and ulna are crushed, remove them all. What is meant, in the books, by par- tial excision is the removal of a portion of the joint—such as a part of the humeral articulation, or the articulating ends of the radius or ulna only. On the contrary, the removal of the entire half of the joint results in a new articulation, and not in anchylosis, as is often