A treatise on fractures in the vicinity of the joints, and on certain forms of accidental and congenital dislocations.

  • Smith, Robert William.
Date:
1850
Catalogue details

Licence: Public Domain Mark

Credit: A treatise on fractures in the vicinity of the joints, and on certain forms of accidental and congenital dislocations. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    and to the pelvis, yet I feel convinced that such is not the object for the attainment of which they are deposited; the final cause of their formation is the union of the fracture already described as traversing the intertrochanteric space, and the constant exist- ence of which, in cases of extracapsular impacted fractures, has been overlooked by the generality of writers. When the patient survives the accident sufficiently long, bony consolidation takes place between the opposed surfaces of the im- pacted cervix and of the shaft, but this union is never accom- plished with so much facility, or at so early a period, as that of the fracture through the trochanter; the latter I have frequently found united firmly by bone, while the neck of the femur has, upon being left for some time in water, become loose in the cavity which it had formed for itself between the trochanters: in these cases the bond of union between the cervix and the shaft is gene- rally a cartilaginous, or fibro-cartilaginous, structure of extreme density and great strength, and which, along with the mechani- cal support resulting from the impaction, enables the patient to bear his weight upon the limb before the osseous union of the cervix with the shaft has been accomplished. When the neck of the femur is broken external to the capsule, the line of fracture is usually transverse with respect to the direc- tion of the axis of the neck, but in some instances the fracture passes downwards and outwards so obliquely that a portion of the great trochanter remains connected with the upper fragment, while in other cases the obliquity is in the reverse direction; and Vidal mentions his having seen one instance in which the obliquity downwards and inwards was such, that the trochanter minor re- mained with the superior fragment ; such cases are, however, . correctly speaking, examples of fracture through the trochanter, rather than of the neck of the bone. The extracapsular fracture is frequently accompanied by extensive ecchymosis, and upon post mortem examination we occasionally find that the effused blood has separated from each other the muscles of the thigh, even as low as the knee-joint; the surfaces of the fracture bleed freely, and in recent cases we find clots of blood occupying the space or cavity circumscribed by the fragments of the shattered bone. The haemorrhage from the lacerated vessels of the cancel-