On the treatment of fractures of the femur by a simple modification of Liston's splint : with observations on re-fracture of the bone in cases of deformity / by Richard G. H. Butcher.

  • Butcher, Richard G. H., 1819-1891.
Date:
1853
Catalogue details

Licence: Public Domain Mark

Credit: On the treatment of fractures of the femur by a simple modification of Liston's splint : with observations on re-fracture of the bone in cases of deformity / by Richard G. H. Butcher. Source: Wellcome Collection.

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    copied into almost every work on surgery witbout comment. I do not mean to say, the upper fragment never projects for¬ wards, but I deny altogether the frequency of its occurrence. Sir A. Cooper even gives a plate showing the abnormal pro¬ jection of the superior fragment, and says, “ a better idea of the effect of this accident may be obtained by a view of the plate, in which the bone will be observed to be united not only with ex¬ treme shortening, butwith a hideous projection forwards.” Now in the case of Toole, there was no doubt of the bone being frac¬ tured just below the lesser trochanter; from the axis of the fragments, and their point of junction, it was concluded so; and from their re-fracture it was confirmed, because the callus yielded at that part corresponding to the original separation. Yet here, in this instance, though the parts were left uncon¬ trolled, owing to the unsteadiness and irregularity of the patient, there is no projection forward of the upper fragment, but there is “ horrid deformity” created by the bones being dragged out¬ wards, and forming an angle salient in that direction. The plate referred to by Sir A. Cooper merely shows the lower fragment drawn up nearly to the root of the great trochanter, and united there; the preparation is said to be in the Museum of St. Thomas’ Hospital; but of this specimen there is no ac¬ curate information recorded. In Mr. Hind’s book, “ On the Causes of Displacement of the Bones of the Extremities in Fracture,” the following de¬ scription is given of this fracture: “ The displacement is greater in the upper than in the lower portion of the bone; it will be found projecting almost at a right angle with the pelvis, producing the elevation already described in consequence of the actions of the psoas magnus and iliacus internus.” In ac¬ cordance with these words, we also find a plate in the vo¬ lume, showing the relative position of the fragments, the upper riding over the lower; but there is no proof given that such a specimen ever existed, from which the drawing might have been taken. Now in the case of Jackson, No. ii., there was clear evi¬ dence of fracture below the lesser trochanter, traversing from without, downwards and inwards, with considerable obliquity; so as to allow the fragments to pass each other, the lower being drawn upwards and outwards, contrary to what usually occurs, owing to the action of the adductors preponderating; in this instance, all anterior projection of the upper fragment was pre¬ vented by the lower resting upon it; in Case No. iv. we have evidence of an almost exactly similar displacement, and the same force counteracting deformity. I may state here, that c