Fractures

This historic book may have numerous typos and missing text. Purchasers can download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated. 1900 Excerpt: ...perfect under almost any immobilizing treatment. The rule that osteotomy must be resorted to in case the function of the extremity is disturbed applies to all the various types of fractures of the leg in which union has taken place in a faulty position, provided the proper time for bloodless redressement has elapsed. The modus operandi is practically the same as that described for osteotomy of the femur--that is, chiseling off of protruding or intervening fragments, or severing the displaced fragments entirely by means of a chisel or the Gigli wire saw. (Compare p. 189.) Pseudoarthrosis requires osteotomy much more frequently, especially in children, in whom the fractured ends have a tendency to become thin and atrophic, thus reducing the extent of their surface, which is a most unfavorable item in the question of agglutination. Such patients are unable to work without an immobilizing apparatus or a prosthesis. Wherever the surfaces are too small for perfect approximation, the bone-fragments should be freshened laterally and united by strong silver wire. (See Fig. 13 c.) It is of the greatest importance that no periosteum should be sacrificed during the operation. In the event of extensive loss of substance of the tibia, the upper tibial fragment may be united with the lower portion of the fibula after the latter has been trimmed proportionally. FOOT. Fracture of the foot concerns either the tarsal or the metatarsal bones or the phalanges. Fractures of the tarsal bones are always caused by direct violence (passing of a carriage-wheel (Fig. 144), falling of a heavy weight upon the tarsus). There is often extensive destruction of the soft tissues present at the same time. The astragalus and calcaneum are the tarsal bones most frequently involved in these frac...