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A practical treatise
on fractures and dislocations
Frank Hastings Hamilton
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I
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PRACTICAL TREATISE
OK
FEACTUMS MD DISLOCATIONS.
BY
FRMK HASTINGS HAMILTON, A.M., M.D., LL.D.,
PmOPBSIOR OP THB PBACTICB OP SUROBXT WITH OPBRATIOHB, IH BBLLBTDB BOSPITAL MBDICAL COLLBGB;
•UBaaOJI TO BBLLBTUB HOSPITAL, HBW TOEK ; COHSITLTIHa 8ITB0B0H TO HOgPITAL POB BUPTURBO
AMD 0BIPPLB8 ; AUTHOR OP A TRBATIBB ON MILITABT SOEaBRT AND HTGIBBB.
FOURTH EDITION,
REVISED AND IMPROVED.
ILLUBTBATBD WITH
THREE HUNDRED AND TWENTY-TWO WOOD-CUTS.
-m
m.^
tt. •%,
PHILADELPHIA:
HE]S"ET 0. LEA.
1871.
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Enterod aooording to the Act of Congress, in the year 1871, by
HENBT 0. LEA,
in the Office of the Librftrian of Congress. All righta reeerred*
FBILADELFBIA t
OOLUirS, PRIMTKE, 196 JATNV 8TRIBT.
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PREFACE TO THE FOURTH EDITION.
Discussions which occupied considerable space in previous editions
have been omitted in the present ; such, for example, as that relating
to the value of certain specimens claiming to represent bony union
after intra-capsular fractures of the neck of the femur. Many obsolete
forms of apparatus have, also, been excluded. This has been done to
make room for the more practical observations, and more efficient
apparel which later experience has supplied. Nearly one-fourth of
the whole number of illustrations has been changed, and in most
cases by the substitution of original wood-cuts. The volume has
J)een especially enriched by the introduction of several of the beauti-
ful illustrations contained in Dr. Bigelow's treatise on ITie Mechanism
of Dislocation and Fracture of the Hip. Since Sir Astley Cooper
wrote, probably no one man has thrown so much light upon the sub-
ject of hip-joint accidents, or contributed so much toward an accurate
and systematic plan of treatment, as the distinguished Boston sur-
geon.
During the last fifteen or twenty years, the progress of knowledge
in the diagnosis, pathology, and treatment of both fractures and dis-
locations has been steady and rapid. Diagnosis has been rendered
more accurate, treatment has acquired a more scientific basis, and
results are in an appreciable degree more satisfactory. The occasion
seems suitable, therefore, to remind the reader of the excellent and
inspiring words of Pearson : —
" If the prospect of that which remains to be done, after the lapse
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IV PREFACE TO THE FOURTH EDITION.
of SO many ages, tends to abate hope and discourage endeavor, yet it
should be remembered that no man can determine the measure of
success which may be connected with industrious research and zeal-
ous exertion."
48 Wbat 82d Stbbbt, N. Y.,
July 1, 1871.
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PREFACE TO THE FIRST EDITION.
The English language does not at this moment contain a single com-
plete treatise on Fractures and Dislocations. The two small volumes
of Desault, and the one of Boyer, issued near the close of the last
century, and translated into English early in this, may perhaps pro-
perly enough have been regarded as complete treatises at the time
of their publication, but they certainly cannot be so considered now.
The several chapters on "Diseases and Injuries of the Bones,^^ contained
in the Legons Ordks of Dupuytren, translated in 1846, and the Trea-
tise on Fractures in the Vicinity of the Joints, and on Certain Forms of
Accidental and Congenital Dishcations,hy'Roh^Tt^m\\ht2kr^ invaluable
monographs^ but neither of them claims to be anything more than a
collection of occasional and miscellaneous papers. The writings of
Amesbury and of Lonsdale relate only to fractures. Even the justly
celebrated quarto of Sir Astley Cooper is no more than what its title
plainly declares it to be, J. Treatise on Dislocations and on Fractures of
the Joints; but since the announcement of the present volume, a trans-
lation of Malgaigne's great and crowning work on Fractures and
Dislocations has been commenced by Dr. Packard, of Philadelphia,
and the first volume has been placed in the hands of the American
profession. Should the remaining volume be rendered into English,
the gap in our literature will be measurably filled.
Under these circumstances I might scarcely have thought it worth
while to continue my labors, already so near their completion, had it
not seemed to me that Malgaigne, whose researches have been truly
marvellous, had failed in some measure to give a just representation
of the observations and improvements which have been made from
time to time by my own countrymen.
Th econtributions of American surgeons to this department had to
be sought chiefly in medical journals, many of which have long been
discontinued, and most of which were inaccessible to the great French
writer. Even to an American, the labor of exhumation from archives
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VI PREFACE TO THE FIRST EDITION.
hitherto almost unexplored has not been small ; and it is probable
that many valuable papers have been overlooked ; indeed it is impos-
sible that it should be otherwise.
I am free to say, also, that I have been encouraged by a hope that
my own personal experience, obtained during many years of public
and private service, might be of some value to my contemporaries.
Very little space has been devoted t9 what is now only historical,
except so far as was necessary to correct certain time-cousecrated
errors, or to confirm and illustrate the practice of the present day ;
but by a pretty full report of characteristic examples, selected from
more than one thousand cases already published by myself, by copious
references to the examples recorded by others, and by a careful exclu-
sion of whatever has not been confirmed by experience or established
by dissection, I have endeavored to make this treatise useful both to
the student and practical man, and a reliable exponent of the present
state of our art upon those subjects of which it treats.
In order to render the description of the various forms of apparatus
employed in the treatment of fractures more intelligible, and to avoid
the necessity of lengthened explanations, a large number of illustra-
tions have been introduced, more, perhaps, than might be thought
necessary, especially as in several instances the apparel which is figured
is not that which is recommended by the author. It is believed, how-
ever, that by a study of the principal forms of approved dressings the
reader will be better prepared for the exigencies of practice ; and that
by the simultaneous presentation of those which are not approved, he
will be saved from a wasteful expenditure of his time in the contriv-
ance of useless apparatus. It is not in the discovery and multiplica-
tion of mechanical expedients that the surgeon of this day declares his
superiority, so much as in the skilful and judicious employment of
those which are already invented.
The author desires to acknowledge his indebtedness to very many
of his professional brethren, throughout the United States, for the
promptness with which they have responded from time to time to his
inquiries, and for the generosity with which they have opened their
pathological collections and placed valuable specimens at his disposal.
He wishes also to express his special obligations to Dr. J. B. Lothrop,
of this city, who has kindly aided him in revising most of the proof-
sheets as they have been issued from the press.
FRANK H. HAMILTON.
Buffalo, KY., December, 1859.
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CONTENTS.
PART I.
FRACTUEES.
CHAPTER I.
PAGE
GeNEBAI. D1VI8IOK OF FBACTUBB8 ...... 27
CHAPTER II.
Gekbbai; Etiology op Practubes ...... 29
CHAPTER III.
Genebal Semeiologt AiTD Diagnosis ..... 88
CHAPTER IV.
Refaib of Bbokek Bones . . - .88
CHAPTER V.
Genebal Tbeatment OF Fbactubes .44
CHAPTER VI.
Delated Union and Non-Union of Bbokbn Bones .62
CHAPTER VII.
Bending, Pabtial Fbactubes, and Fisstjbes of the Long Bones 72
§1. Bending of the Long Bones ...... 72
§ 2. Partial Fracture of the Long Bones . .76
§ 8. Fissures ......... 84
CHAPTER VIII.
Fbactubes OF THE Nose ....... 89>
gl. OssaNasi 89
§ 2. Fractures and Displacements of the Septum Narium .. 94
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CONTENTS.
CHAPTER IX.
Fractubes op the Malar Bone . .
PAGE
97
CHAPTER X.
Fractures op the Upper Maxillary Bones
100
CHAPTER XI.
Fractures op the Zygomatic Arch
CHAPTER XII.
Fractures op the Lower Jaw
106
109
CHAPTER XIII.
Fractures op the Hyoid Bone
CHAPTER XVI.
Fractures op the Sternum ....
CHAPTER XVII.
Fractures op the Ribs and their Cartilages
§ 1. Fractures of the Ribs ....
§ 2. Fractures of the Cartilages of the Ribs
133
CHAPTER XIV.
Fractures op the Cartilages op the Larynx . .138
§1. Thyroid Cartilage .138
§ 2. Thyroid and Cricoid Cartilages . . . .138
§3. Cricoid Cartilage ....... 140
CHAPTER XV.
Fractures op the VERTEBRiB ...... 142
§ 1. Fractures of the Spinous Processes . . . .142
§ 2. Fractures of the Transverse Processes .... 144
. § 3. Fractures of the Vertebral Arches . . . . .145
§ 4. Fractures of the Bodies of the Vertebra . . . .151
1. Fractures of the Bodies of the Lumbar Vertebrs . . 153
2. Fractures of the Bodies of the Dorsal Vertebra 154
3. Fractures of the Bodies of the five lower Cervical Vertebrae . 156
4. Treatment of Fractures of the Bodies of the Vertebrae . 158
g 5. Fractures of the Axis . . . . . . .161
§6. Fractures of the Atlas . ...... 164
§ 7. Fractures of the first two Cervical Vertebrae (Atlas and Axis) at
the same time ....... 164
165
172
172
177
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CONTENTS.
IX
CHAPTER XVIII.
Fragtureb of the Clavicle ....
CHAPTER XIX.
Fractures op the Scapula ....
§ 1. Fractures of the Body of the Scapula
§ 2. Fractures of the Neck of the Scapula
§ 3. Fractures of the Acromion Process .
§ 4. Fractures of the Coracoid Process
CHAPTER XX.
Fractures of the Humerus . . ...
§ 1. Fractures of the Head and Anatomical Neck
§ 3. Fractures through the Tubercles .....
g 8. Longitudinal Fractures of the Head and Neck, or Splitting off of
the Greater Tubercle . . .
§ 4. Fractures through the Surgical Neck (including Separations at the
Upper Epiphysis) .......
§ 6. Fractures of the Shaft below the Surgical Neck, and above the Base
of the Condyles ... ....
§ 6. Fractures at the Base of the Condyles (including Separations of the
Lower Epiphysis) .......
§ 7. Fractures at the Base of the Condyles, complicated with Fracture
between the Condyles, e^rtending into the Joint .
§ 8. Fractures of the Internal Epicondyle ....
§ 9. Fractures of the External Epicondyle ....
§ 10. Fractures of the Internal Condyle .....
§11. Fractures of the External Condyle .....
CHAPTER XXI.
Fractures op the Radius . . . - .
CHAPTER XXII.
Fractures op the Ulna . . . . . . .
§1. Shaft of the Ulna ... . . .
§ 2. Coronoid Process of the Ulna .....
§ 3. Fractures of the Olecranon Process .....
f
CHAPTER XXIII.
Fractures op the Radius and Ulna .....
page
178
203
202
206
208
211
218
215
219
219
221
284
245
258
256
260
261
268
267
297
297
301
810
818
CHAPTER XXIV.
Fractures op the Carpal Bones .
827
CHAPTER XXV.
Fractures op the Metacarpal Bones
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X COXTEKTS.
CHAPTER XXVL
PAGE
FbAGTUBBS OF THE FiNGBRB ....... 881
CHAPTER XXVII.
FBACTT7BBB OF THE PeLYIS, AND TBAUHATIC SePABATIONS AT ITS StM-
PHYBES . ... . . . . . . . 834
§ 1. Pubes 885
§2. Ischium ........ 888
§8. Ilium 840
§4. Acetabulum ........ 848
§ 5. Sacrum . . . * 849
§6, Coccyx 861
CHAPTER XXVIII.
Fbactubeb OF THE Femub ....... 852
§1. Neck of the Femur ....... 852
(a.) Neck of the Femur within the Capsule . . .858
(&.) Neck of the Femur without the Capsule . . . 876
(c.) Fractures of the Neck partly within and partly without the
Capsule 882
§ 2. Fracture through the Trochanter Major and Base of the Neck of
the Femur ........ 888
§ 8. Fracture of the Epiphysis of the Trqphanter Major . . 884
§ 4. Fractures of the Shaft of the Femur . . . . .886
§ 5. Fractures of the Condyles . . . . . .428
(a.) Fractures of the External Condyle . . . .428
(&.) Fractures of the Internal Condyle . . . .429
(6.) Fractures between the Condyles and across the Base . 481
CHAPTER XXIX.
Fbactubes of the Patella ' . . . . 484
CHAPTER XXX.
Fbactubes OF THE Tibia ....... 444
CHAPTER XXXI.
Fbactubes OF THE Fibula ....... 449
CHAPTER XXXII.
Fbactubes of the Tibia and Fibula . . . . .458
CHAPTER XXXIir.
Fbactubes of the Tabsal Bokes . . .476
CHAPTER XXXIV.
Fbactubes of the Metatabsal Bones . . .481
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CONXEXTS.
XI
CHAPTER XXXV.
Fbactubes of thb Phalanges of thb Toes
CHAPTER XXXVI.
Gunshot Fbactubes .....
PAGE
483
. 488
PAET 11.
DISLOCATIONS.
CHAPTER I.
Gbnsbal Considebations ....... 493
g 1. General Diyision and Nomenclature . . . . . 493
§ 2. General Predisposing Causes ...... 494
g 8. Direct or Exciting Causes ...... 495
g 4. General Symptoms ....... 495
g 5. Pathology .497
g6. General Prognosis . . . . . . .498
g7. General Treatment . 498
CHAPTER II.
Dislocations of the Loweb Jaw . . . . . .501
g 1. Double or Bilateral Dislocations . . . . .601
g 2. Single or Unilateral Dislocations ..... 505
g 3. Conditions of the Jaw simulating Luxations . . . 506
CHAPTER III.
Dislocations of the Spine . . . .608
g 1. Dislocations of the Lumbar Vertebrae . . . .609
g 2. Dislocations of the Dorsal Vertebrce 610
g 3. Dislocations of the Six Lower Cervical Vertebra . . .513
g 4. Dislocations of the Atlas . ..... 519
g 5. Dislocations of the Head upon the Atlas, or Occipito-Atloidean
Dislocations ........ 521
CHAPTER IV.
Dislocations of the Ribs ....... 521
gl. Dislocations of the Ribs from the Vertebrae . . .521
g 2. Dislocations of the Ribs from the Sternum . . . .523
g 8. Dislocations of one Cartilage upon another . . . .524
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XU CONTENTS.
CHAPTER V.
PAGE
Dislocations op the Clavicle . . . . . .524
§ 1. Dislocations Forwards at the Sternal End .... 524
§ 2. Dislocations of the Stomal End of the Clavicle Upwards . . 528
§ 3. Dislocations of the Sternal End of the Clayicle Backwards . 530
§ 4. Dislocations of the Acromial End of the Clavicle Upwards . 582
§ 5. Dislocations of the Acromial End of the Clavicle Downwards . 537
§ 6. Dislocations of the Acromial End of the Clavicle under the Coracoid
Process ........ 588
§ 7. Dislocation of the Clavicle at both Ends . . . .589
CHAPTER VI.
Dislocations op the Shouldeb (Huhebus at its Uppbb Extbemitt) 540
§ 1. Dislocations of the Shoulder Downwards (Subglenoid) . . 540
Dislocation, with Fracture of the Humerus near its Upper End . 565
g 2. Dislocations of the Humerus Forwards (Subcoracoid and Subcla-
vicular) . . . . . . . . .566
§ 8. Dislocations of the Humerus Backwards (Subspinous) . . 572
§ 4. Partial Dislocations of the Humerus ..... 576
CHAPTER VII.
Dislocations op the Head op the Radius ..... 579
§ 1. Dislocations of the Head of the Radius Forwards . . . 579
g 2. Dislocations of the Head of the Radius Backwards . . . 584
§ 8. Dislocations of the Head of the Radius Outwards . . .586
CHAPTER VIII.
Dislocations op the Uppbb End op the Ulna Bacewabds . . 587
CHAPTER IX.
Dislocations op the Radius and Ulna (Fobeabm at the Elbow-Joint) 588
§ 1. Dislocations of the Radius and Ulna Backwards . . .588
§ 2. Dislocations of the Radius and Ulna Outwards (to the Radial Side) 598
§ 8. Dislocations of the Radius and Ulna Inwards (to the Ulnar Side) . 602
§ 4. Dislocations of the Radius and Ulna Forwards . . .605
CHAPTER X.
Dislocations op the Wbist (Radio-Cabpal Abtioulation) . . 606
§ 1. Dislocations of the Carpal Bones Backwards . . . 608
§ 2. Dislocations of the Carpal Bones Forwards . . . .611
CHAPTER XI.
Dislocations op the Loweb^^End op the Ulna (Inpebiob Radio-Ulnab
Abticulation) . . . . . . . .612
§ 1. Dislocations of the Lower End of the Ulna Backwards . .612
§ 2. Dislocations of the Lower End of the Ulna Forwards . . 614
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CONTENTS.
XIU
CHAPTER XII.
DiBLOGATIOKB 07 THE CaSPAL BoNES (AMONG THEMSELVES)
CHAPTER XIII.
DiSLOOATIOKS 07 THE MeTAOABPAL BoNES (AT THE CABFO-MeTACABPAL
Abticulatiohb) ........
PAGE
616
617
CHAPTER XIV.
Dislocations op the First Phalanges op the Thumb and Fingebs (at
THE Metacabpo-Phalangbal Abtigulations) .... 620
§ 1. Dislocations of the First Phalanx of the Thumb Backwards . 620
§ 2. Dislocations of the First Phalanx of the Thumb Forwards . 627
§ 8. Dislocations of the First Phalanx of the Fingers . . .628
CHAPTER XV.
Dislocations op the Second and Thibd Phalanges op the Thumb
AND Fingebs
CHAPTER XVI.
Dislocations op the Thigh (Goxo-Femobal) ....
§ 1. Dislocations Upwards and Backwards on the Dorsum Ilii .
' § 2. Dislocations Upwards and Backwards into the Great Ischiatic
Notch. ........
§ 8. Dislocations Downwards and Forwards into the Foramen Thy-
roideum ........
g 4. Dislocations Upwards and Forwards upon the Pubes
g 5. Anomalous Dislocations, or Dislocations which do not properly
belong to either of the four principal divisions before described
1. Dislocations directly Upwards .....
2. Dislocations Downwards and Backwards upon the Posterior
Part of the Body of the Ischium, between its Tuberosity and
its Spine . . .
8. Dislocations Downwards and Backwards into the Lesser or
Lower Ischiatic Notch .
4. Dislocations directly Downwards
6. Dislocations Forwards into the Perineum
g 6. Ancient Dislocations of the Femur .
g 7. Partial Dislocations of the Femur
g 8. Coxo-Femoral Dislocations, complicated with Fracture of the Femur
g 9. Voluntary Dislocations of the Femur ....
CHAPTER XVII.
Dislocations op the Patella
g 1. Dislocations of the Patella Outwards
g 2. Dislocations of the Patella Inwards .
§ 8. Dislocations of the Patella upon its Axis
g 4. Dislocations of the Patella Upwards .
629
634
660
674
678
678
688
684
686
690
691
694
696
696
699
699
702
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XIV
CONTENTS.
CHAPTER XVIII.
PAGK
Dislocations of thb Hbad of the Tibia . . . . .703
§ 1. Dislocations of the Head of the Tibia Backwards . . .704
§ 2. Dislocations of the Head of the Tibia Forwards . . .706
§3. Dislocations of the Head of the Tibia Outwards . . .708
§4. Dislocations of l^e Head of the Tibia Inwards . .709
§ 5. Dislocations of the Head of the Tibia Backwards and Outwards . 710
§ 6. Internal Derangement of the Knee-Joint . . . .711
CHAPTER XIX.
Dislocations of the Lowbb End of the Tibia .
§ 1. Dislocations of the Lower End of the Tibia Inwards
§ 2. Dislocations of the Lower End of the Tibia Outwards
§ 3. Dislocations of the Lower End of the Tibia Forwards
§ 4. Dislocations of the Lower End of the Tibia Backwards
713
714
718
730
724
CHAPTER XX.
Dislocations of the TJppeb End of the Fibula .
§ 1. Dislocations of the Upper End of the Fibula Forwards
§ 2. Dislocations of the Upper End of the Fibula Backwards
725
725
726
CHAPTER XXI.
Dislocations of the Infebiob Peboneo-Tibial Abtigulation
727
CHAPTER XXII.
Tabsal Luxations ....
§ 1. Dislocations of the Astragalus .
§ 2. Astragalo-Calcaneo-Scaphoid Dislocations
g 3. Dislocations of the Calcaneum
§4. Middle Tarsal Dislocations .
§ 5. Dislocations of the Os Guboides
g 6. Dislocations of the Os Scaphoides
g 7. Dislocations of the Cuneiform Bones
727
727
735
730
737
737
737
738
CHAPTER XXIII.
Dislocations of the Metatabbal Bones .
740
CHAPTER XXIV.
Dislocations of the Phalanges of the Toes
742
CHAPTER XXV.
Compound Dislocations of the Long Bones
743
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CONTENTS.
XV
CHAPTER XXVI.
GOKGENITAL DiBLOCATIONB ....
§ 1. General Observations and History
§3. Etiology
§ 3. Congenital Dislocations of the Inferior Maxilla
g 4. Congenital Dislocations of the Spine .
g 5. Congenital Dislocations of the Pelvic Bones
g 6. Congenital Dislocations of the Sternum
g 7. Congenital Dislocations of the Clavicle
g 8. Congenital Dislocations of the Bhonlder (Upper End of the Hame
rus) .......
g 9. Congenital Dislocations of the Radios and Ulna Backwards
g 10. Congenital Dislocations of the Head of the Radius
g 11. Congenital Dislocations of the Wrist
g 12. Congenital Dislocations of the Fingers
gl8. Congenital Dislocations of the Hip .
g 14 Congenital Dislocations of the Patella
g 15. Congenital Dislocations of the Knee
g 16. Congenital Dislocations of the Tarsal Bones
g 17. Congenital Dislocations of the Toes
PAGB
758
758
760
761
764
765
765
766
766
770
770
771
773
773
778
779
783
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LIST OF ILLUSTRATIONS.
FIO.
1.
2.
8.
4.
6.
6.
7.
8.
9.
10.
11.
12.
18.
14.
15.
16.
17.
18.
19.
20.
21.
24.
25.
26.
27.
80.
31.
84.
85.
FRACTURES.
Perforating and longitudinal fracture
Impacted extra-capsular fracture of neck of femur
Union of fracture wth the fragments widely separated