Frank Hastings Hamilton.

A practical treatise on fractures and dislocations online

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Fracture united i;\'ith an oblique callus

Application of the roller, by circular and reversed turns

Many-tailed bandage

Application of the many-tailed bandage

Bandage of Scultetus

Wood and leather splint

Starch bandage applied for a broken thigh

Seutin's pliers

Opening the apparatus with Sen tin's pliers

Apparatus immobile, applied over a compound fracture

Clavicle, united by ligamentous bands

Hudson^ s splint, ununited fracture .

Physick's first case, treated by seton — after 28 years

Dieffenbach's drill for ununited fracture

Brainard's perforator for ununited fracture

Bone-drill ......

Gaillard's instrument for ununited fractures
Fergusson's case of permanent bending without fracture
Partial fracture of the femur without restoration of the bone to its
form .......

Partial Jfracture of the clavicle without spontaneous restoration
Partial fracture after union is consummated
Fracture of the lower jaw .
Bean's maxillary articulator
Beanos apparatus for broken jaw, applied .
Gibson's bandage for a fractured jaw
Barton's bandage for a fractured jaw
Four-Uiled bandage or sling for the lower jaw
The author's apparatus for a broken jaw .
Fracture of the spinous process
Fracture of the vertebral arches
Oblique fracture of the body of a vertebra
Key's case of fracture of the first lumbar vertebra
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XVIU



LIST OF ILLUSTRATIONS.



FIG,

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Wire bed .......

Parker's case of fracture of the odontoid process of the axis
Development of sternum .....

Fracture of the ribs, with lateral union

Complete oblique fracture of the clavicle .

Fracture of the clavicle outside of the trapezoid ligament

Complete oblique fracture of the clavicle at the outer end of the inner

fwo-thirds .......

Comminuted fracture of the clavicle united

Velpeau's dressing for fractured clavicle .

Figure-of-8 bandage, for a fractured clavicle

^loore's apparatus for fractured clavicle

Say re's apparatus for fractured clavicle

Say re' 8 apparatus for fractured clavicle

Say re's apparatus for fractured clavicle

Bartlett's apparatus for fractured clavicle .

Fox's apparatus for fractured clavicle . . .

The author's apparatus for fractured clavicle . i .

Fracture of angle of the scapula ....

Fractures of the body and acromion process of the scapula

Comminuted fracture of the glenoid cavity

Fracture of the neck of the scapula

Scapula with epiphyses .....

Fracture of the coracoid process ....

Fracture at the anatomical neck of the humerus .

61. Pope's specimen of supposed fracture at the anatomical neck of the

humerus, and reversion of the head — front and side views
Humerus with epiphyses
Fracture of surgical neck of humerus
Welch's arm splint .
Plan of author's leather arm splint .
Leather splint closed at lop and complete
Lonsdale's apparatus for extension," in fractures of the humerus
Martin's extension in fractures of the humerus
Clark's extension in fractures of the humerus
Fracture of the humerus at the base of the condyles
Separation of lower epiphyses ....

Physick's elbow splint .....

Kirkbride's elbow splint .....

Hose's arm and forearm splint ....

"Welch's arm and forearm splint ....

Bond's elbow splint ......

The author's elbow splint .....

Fracture at the base of the condyles of the humerus, and between the

condyles ......

Fracture of internal epicondyle of the humerus .

Fracture of external epicondyle

Fracture of tlie internal condyle of the humerus .

Fracture of external condyle

Miitter's specimen of fracture of the neck of the radius

Fracture of head of radius ....



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LIST OF ILLUSTRATIONS. XIX

PIG. PAGE

85. Scott's apparatus for fractures of the forearm . . .272

86. Fracture of the shaft of the radius . . . .273

87. Colics' fracture — radius near its lower end .... 275

88. Bigelow's case of comminuted fracture of the lower end of the radius . 279

89. Nelaton's splint for fracture of the radius near its lower end . . 285

90. Bond's splint for fracture of the lower end of the radius . . 285

91. Hay's splint for fracture of the lower end of the radius . 285

92. E. P. Smith's splint for fractures of the lower end of the radius— front

view . . . . . . . . .286

93. Same as above — back view ...... 286

94. Shrady's splint for Colics' fracture . . . .286

95. The author's splint for fracture near the lower end of the radius . 290

96. The author's dressing for a fracture of the radius near its lower end —

complete . ." . . . . . .291

97. Radius, with epiphyses ....... 296

98. Fracture of the shaft of the ulna ... . . . .297

99. Fracture of the coronoid process of the ulna .... 302

100. Ulna, with epiphyses . . . . . . .805

101. Fracture of the olecranon process at its base . . . .311

102. Olecranon process united by ligament . . . . . 313

103. Sir Astley Cooper's method of dressing a fracture of the olecranon

process ......... 315

104. The author's splint for a fracture of the olecranon process, applied . 316

105. Fracture of the radius and ulna in the middle third . .318

106. Fracture of the radius and ulna in the lower third , .319

107. Radius and ulna united with displacement . . . .819

108. Development of os innominatum ...... 335

109. Clark's case of comminuted fracture of the pelvis . . 337

110. Development of femur . . . . ... . 352

111. Fracture of the neck of the femur, within the capsule . . . 354

112. Impacted fracture of the neck of the femur, within the capsule . 356

113. Horizontal section of the neck of the femur .... 359

114. Extra-capsular fracture with inversion . , . . . 359

115. Vertical section of Mrs. Wakelee's femur, acetabulum, and capsule . 365

116. Impacted fracture within the capsule . . . ' . . 866

117. Section of the head and neck of the sound femur of an adult . .367

118. Chronic rheumatic arthritis, in hip-joint * . . . . 368

119. Crosby's specimen of fracture of neck of femur within the capsule —

ununited ......... 371

120. Mayo's specimen of fracture of the neck of the femur within the cap-

sule — united by ligament ....... 371

121. Author's apparatus for fractures of the neck of the femur . . 872

122. Gibson's modification of Hagedom's thigh splints . . . . 373

123. Gibson's splint applied ....... 873

124. 125, 126. Impacted extra-capsular fracture .... 377
127. Fracture of the neck of the femur . . .379
12^. Extra-capsular fracture of the neck of the femur — ununited . . 380

129. Extra-capsular fracture of the neck of the femur — with excess of callus 380

130. Extra-capsular fracture of the neck of the femur — united with irregular

callus ......... 381

181. Miller's splint for extra-capsular fractures ..... 882



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XX



LIST OF ILLUSTRATIONS.



FIG.

182. Sir Astley Cooper's mode of treating fractures of the trochanter major

133. Fracture of the femur at the base of the condyles

134. Physick's thigh splint ......

135. Liston's dressing of fractured femur with a straight splint

136. Double-inclined plane in Middlesex Hospital, London

137. Amesbury's double-inclined plane .....

138. Amesbury's splint applied . . . . . .

139. Boyer's thigh splint applied .....

140. Nathan R. Smith's suspending thigh splint, or double-inclined plane

141. Nott's double-inclined plane .....

142. N. R. Smith's anterior splint . . . . .

143. N. R. Smith's anterior splint, applied . . . ' . !

144. Palmer's modification of the anterior splint . . . '

145. Hodgen's suspension apparatus . . . ' . . I

146. NeiU's straight thigh splint, for extension and counter-extension '

147. Flagg's thigh apparatus — employed in the Massachusetts General Hos

pital. Pelvic belt and perineal straps .

148. Same — foot-piece and screw

149. Same — lateral view of the apparatus, without the belt

150. Same — front view, with folded sheets laid across .

151. Same — apparatus applied, front view

152. Same — apparatus applied, side view

153. Same — mode of applying adhesive plasters to leg

154. Same — mode of making extension by adhesive plasters

155. Same — ^perineal band secured with a padlock

156. Sanborn's thigh splint

157. Gurdon Buck's fracture apparatus .

158. Homer's thigh splint
152. Joseph Hartshorne's thigh splint .

160. Gilbert's extension in fracture of the thigh

161. Gilbert's extension applied to both thighs .

162. H. L. Hodge's counter-extension in fractures of the thigh

163. Lente's thigh splint . ' .

164. Burge's apparatus for fracture of femur .

165. Burge's apparatus applied .

166. Extension during application of plaster of Paris

167. Extension continued until the plaster is hard

168. Fracture of femur just below trochanter minor

169. Jenks' fracture-bed

170. Daniels' fracture-bed — descriptive diagram

171. The same — complete

172. The same — ^in use .

173. Crosby's invalid-bed, closed

174. Crosby's invalid-bed, open .

175. Standard for extension

176. Foot-piece .

177. Extension-band and foot-piece

178. Extension -band and foot-piece folded

179. Mode of applying adhesive plaster for extension

180. Author's dressings for fracture of shaft of femur, complete

181. Author's splint for fracture of femur in a child .



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LIST OP ILLUSTRATIONS. XXI

PIG. PAGB

182. Author's dressing for fracture of femur in a child — complete . 427

183. Crosby's specimen of fracture of the external condyle of the femur 428

184. Sir Astley Cooper's case of fracture of the external condyle of the femur 429

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185. Transverse fracture of the patella .

186. Comminuted fracture of the patella

187. Transverse fracture of the patella — exhibiting the relations of the mus-

cles to the fracture ......

188. Fragments of a broken patella separated by flexion of the knee

189. Upper fragment of a broken patella drawn up very much by the action

of the quadriceps femoris

190. The author's mode of dressing a fractured patella

191. Wood's apparatus for a fractured patella .

192. Dorsey's patella splint ....

193. Sir Astley Cooper's method for broken patella by circular and parallel

tapes ........

194. Sir Astley Cooper's method by a leather band and counter-strap

195. Lonsdale's apparatus for fractured patella

196. Malgaigne's hooks for fractured patella ....

197. Burge's apparatus for fractured patella ....

198. Lausdale's apparatus for fractured patella

199. Development of tibia ......

200. Development of fibula ......

201. Fracture of the fibula near its lower end ....

202. Dupuytren's splint incorrectly applied ....

203. Dupuytren's splint, as originally made and applied by himself .

204. Compound and comminuted fracture of the leg .

205. Long splint for fracture of the leg in. Pott's position

206. Plaster of Paris dressing for fracture of leg, and suspension

207. Hutchinson's splint for extension in fractures of the leg

208. Neill's apparatus for fractures of the leg requiring extension and coun

ter-extension .....

209. Keill's apparatus for compound fractures of the leg

210. Gilbert's fracture-box ....

211. Crandall's apparatus for fractures of the leg requiring extension and

counter-extension — side view

212. Same — posterior view of the lower section

213. Same— posterior view of the entire apparatus

214. Liston's double-inclined plane, applied to the leg in a case of compound

fracture .......

215. Bauer's wire splints, for the leg .

216. Swing box, for fractures of the leg ...

217. Salter's cradle for fractures of the leg .

218. Fracture-box for the leg, with movable sides

219. Wire rack, for fracture of the leg ....

220. Malgaigne's apparatus for certain oblique fractures of the leg

221. Malgaigne's apparatus applied ....

222. Apparatus for fracture of the tuberosity of the calcaneum

223. Author's movable canvas for gunshot fractures of thigh

224. Author's movable canvas for gunshot fractures of thigh, with extension,

on horses ......... 487



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xxu



LIST OF ILLUSTRATIONS.



DISLOCATIONS.

PIG. PAGE

^25. Clove-hitch ......... 500

236. Compound pulleys and ring . . . ... 500

227, 228. Double dislocation of the inferior maxilla . . . 508, 504

229. Ayres' case of bilateral dislocation of the fifth cervical vertebra . 519

280. Dislocation of the sternal end of the clavicle, forwards . . . 525

281. Sir Astley Cooper's apparatus for dislocated clavicle . . . 527

282. Dislocation of sternal end of clavicle upwards .... 529
288. Dislocation of the acromial end of the clavicle, upwards . . 583

284. Dislocation of acromial end of clavicle upwards and outwards . . 588

285. Mayor's apparatus for dislocated clavicle ..... 586

286. 287. Dislocation of the shoulder downwards into the axilla . 542, 548

288. New socket, in an ancient luxation of the shoulder downwards . 549

289. N. K. Smith's method of reducing a dislocation of the shoulder . 554

240. La Mothe's method of reducing a dislocation of the shoulder— modified 555

241. Sir Astley Cooper's method, with the heel in the axilla . . . 555

242. Sir Astley Cooper's method, with the knee in the axilla . . • 556

243. Iron knob employed by Skey, instead of the heel . . . 557

244. Skey's method in dislocations of the shoulder . . . . 557

245. Sir Astley Cooper's method, by means of pulleys . . . 558

246. Subcoracoid dislocation of the humerus ..... 567

247. Subclavicular dislocation of the humerus ..... 568

248. Subcoracoid dislocation of the humerus ..... 569

249. Subspinous dislocation of the humerus ..... 574

250. Displacement of the long head of the biceps .... 577

251. Dislocation of the head of the radius forwards — anatomical relations . 580

252. 'Dislocation of the head of the radius forwards . . . .581
258. Dislocation of the head of the radius backwards . . 586

254. Dislocation of the upper end of the ulna backwards . . . 587

255. Dislocation of the radius and ulna backwards .... 589

256. Sir Astley Cooper's method in dislbcation of the radius and ulna back-

wards ......... 598

357. Most frequent form of incomplete outward dislocation of the forearm . 598

258. Most frequent form of incomplete inward dislocation of the forearm . 608

259. Canton's case, dislocation of the radius and ulna forwards . . 605
360, 261. Dislocation of the carpal bones backwards .... 610
262. Dislocation of the carpal bones forwards — skeleton . .611

268. Dislocation of the carpal bones forwards . . . .612

264. Dislocation of the first phalanx of the thumb backwards . . 620

265. Clove-hitch ......... 623

266. Sir Astley Cooper's method of reducing dislocations of the thumb by

the pulleys ........ 628

267. 268. Levis's instrument for reduction of the phalanges . . 625, 626

269. Indian *' puzzle" — employed in the reduction of dislocations of small

joints . . . . . . . . . 626

270. Backward dislocation of the first phalanx of the index finger — reduction

by extension ........ 629

271. Dislocation of the second phalanx backwards .... 680

272. Dislocation of the second phalanx forwards . . . .631



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LIST OF ILLUSTRATIONS.



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FIG.

273. Dislocation of the femur upon the dorsum ilii

274. lUo-femoral ligament ......

275. Dislocation of the femur upon the dorsum ilil, showing relations of ilio

femoral ligament .......

276. Dislocation of the femur upon the dorsum ilii

277. Everted dorsal dislocation .... . .

278. Nathan Smith's method of reduction of a dislocation of the head of the

femur Mpon the dorsum ilii, by manipulation " .

279. Relaxation of the ilio-femoral ligament, by flexion

280. Hippocrates' mode of reducing dislocations of the hip by manipulation

281. Reduction of a dislocation upon the dorsum ilii by pulleys

282. Reduction of a dislocation upon the dorsum ilii by a twisted rope

283. Jarvls's adjuster— applied in dislocation of the hip

284. Bloxham's dislocation tourniquet — ^applied for reduction of a dislocation

of the femur upon the pubes ......

285. Bigelow's tripod for vertical extension .....

286. 287. Dislocation of the femur upwards and backwards into the great

•ischiatic notch ........

288. Internal obturator in its natural position .....

289. Internal obturator in its new position .....

290. Dislocation upwards and backwards into the great ischiatic notch —

"below the tendon," when the patient is recumbent . . 663

291. Reduction of a dislocation into the great ischiatic notch, by pulleys . 666

292. Relations of the ilio-femoral ligament to thyroid dislocations . . 669

293. Dislocation of the femur downwards and forwards into the foramen

thyroideum 4 ....... 669

294. Reduction of thyroid dislocation by manipulation .671

295. Sir Astley Cooper's mode of reducing recent luxations of the femur into

the foramen thyroideum ....... 672

296. Effect of flexion upon the ilio-femoral ligament in the thyroid disloca-

tion ......... 673

297. Specimen of dislocation upon the pubes, in St. Thomas's Hospital . 674

298. Dislocation upon the pubes below the anterior inferior spine of the

ilium ......... 670

299. Dislocation upwards and forwards upon the pubes . 676

300. Reduction of dislocation upon the pubes by extension . . . 678

301. Anterior oblique dislocation ...... 680

302. Mechanism of anterior oblique dislocation . . .681

303. Snpra-spinous dislocation . . . .681

304. 305. Voluntary subluxation upon the dorsum ilii .... 695

306. Dislocation of the patella outwards *..... 697

307. Dislocation of the patella inwards . . . . 699

308. Dislocation of the head of the tibia backwards .... 704

309. Dislocation of the head of the tibia forwards .... 706

310. Subluxation of the,head of the tibia outwards .... 709
811. Subluxation of the head of the tibia inwards . . .710
312, 318. Dislocation of the lower end of the tibia inwards . . 714, 715
314. Reduction of a dislocation of the ankle by pulleys . . .716
815. Dislocation of lower end of the tibia outwards . . . .719
316. Partial dislocation of the tibia forwards, with fractures of malleolus

intemus and fibula — skeleton . . . . . .721



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XXIV



LIST OF ILLUSTRATIONS.



817. Partial dislocation of the tibia forwards, with fracture of the malleolus

intemus and fibula .....

818, 319. Dislocation of the lower end of the tibia backwards

820. Dislocation of the astragalus outwards — anatomical relations

821. Simple dislocation of the astragalus outwards

822. Compound dislocation of the astragalus inwards .



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PART I.



FRACTURES



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FKAOTURES:



CHAPTER I.

GENERAL DIVISION OP FRACTURES.

Fractures are divided into Complete and Incomplete, Simple,
Comminuted, Compound, and Complicated.

A Complete fracture is one in which the line of division completely
traverses the bone.

An Incomplete fracture is a partial separation of the bone : under
which name are included Bending, Partial fractures, Fissures and
Punctured or Perforating fractures, the last of which is almost pecu-
liar to gunshot injuries.

A Simple fracture is one in which the bone is broken at only one
point. The term has no reference to the question of complications,
but in its technical meaning, as employed by both English and Ameri-
can surgeons, it has reference only to the number of fragments into
which the bone is broken. It would be more correct, perhaps, to sub-
stitute the word "single" for "simple," as has been done by Malgaigne
and some other French writers, but I fear that to American surgeons
the substitution would be rather a source of confusion than otherwise.

A Comminuted fracture, called by Malgaigne " multiple," is a frac-
ture in which the bone is broken at more than one point, and in which,
consequently, the bone is divided into more than two fragments. It
is used also in a technical sense, and by no means implies minute
division or comminution of the fragments.

A Compound fracture is technically one in which there exists also
an external wound communicating with the bone at the point of frac-
ture. It may be either partial or complete, simple or comminuted, or
even complicated, while at the same time it is also compound.

Complicated fractures are such as present additional complications,
or complications for which no other specific term has been invented.
Thus, the fracture may be complicated with the lesion of an important
bloodvessel or nerve, or with great contusion or laceration of the soft
parts, with a dislocation, or with fractures of other bones, or even
with some constitutional fault.

Fractures are also divided into Transverse, Oblique, and Longitu-
dinal, according as the direction of the line of separation is at a right
angle with the axis of the bone at the point of fracture, or as it deviates



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28 GENERAL DIVISION OF FRACTURES.

more or less from this direction. But a fracture is called transverse
when it does not traverse the bone precisely at a right angle ; indeed,
we usually apply this term whenever the obliquity is only moderate,
or when, in the examination of a limb, although we are unable to
detect the precise line of the fracture, we ascertain that, without being
impacted or serrated, the ends of the bones continue to rest upon each
other, or, being replaced, do not spontaneously become displaced.

Longitudinal fractures occur generally in connection with oblique
or transverse fractures ; as when the lower end of the femur is split
vertically into the joint, and the shaft of the bone is traversed hori-
zontally by a fracture which intercepts the vertical or longitudinal
fracture. A fracture of a condyle or of any projection from the
body of the bone is called longitudinal if the direction of the line of
fracture is parallel, or nearly so, to the axis of the shaft.

Fig. 1. Fig. 2.



Perforating and longitndinal fraetare. Impacted, extra-capsalar fracture

of neck of femar.

A Serrated fracture is one in which the opposite surfaces denticu-
late, the elevations upon one fragment being reflected by corresponding
depressions upon the other.

Impacted fractures are those in which the fragments are driven into
each other, the lamellated structure of one fragment penetrating the
cancellous structure of the other.

Writers also occasionally speak of fractures en rave, en bee deflate,
en bee de plume, spiroid, cuneate, &c. ; but we do not see the propriety
of multiplying the divisions and encumbering our nomenclature by
these fancied resemblances. For all useful purposes, the divisions
above given are sufficient.

Epiphyseal separations we shall not hesitate to class with fractures,
and to submit them to the same rules of nomenclature. These acci-
dents rarely occur after the twentieth year of life; since after this
period, and in the case of some bones at a much earlier period, the
epiphyses are united to the diaphyses by bone.



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GENERAL ETIOLOGY OF FRACTURES. 29



CHAPTER II.

GENERAL ETIOLOGY OF FRACTURES.

The causes of fracture may be considered as predisposing and
exciting.

Predisposing Causes, — Partial fractures, with bending of the bones,
are most frequent in infancy and childhood ; but complete fractures
occur most often during manhood ; and if they are again less frequent



Online LibraryFrank Hastings HamiltonA practical treatise on fractures and dislocations → online text (page 2 of 100)