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

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.

23/36 page 19

$me. In this preparation the superior fragment lies in front of the lower; from the anterior surface of the shaft of the bone a third piece was detached, fully three inches long, which was displaced upwards; it never after regained its normal position, but became united as a wedge between the two frag¬ ments, producing prominence of the upper, which must have been remarkable during life. All are bound together by a thick bond of callus posteriorly. Amongst all the preparations of fractures, traversing the upper part of the thigh bone, and in which the pathological department of the Museum of the College is very rich, there is not a single specimen where fracture has occurred below the lesser trochanter, which exhibits the superior fragment lying in front of the lower, while, as already observed, there are se¬ veral to prove the converse of the proposition. Again, there is not a specimen to demonstrate a transverse solution of con¬ tinuity in the bone below the trochanters—all are alike charac¬ terized by their obliquity and extent of fracture. I have stated before that I do not mean to deny the possibility of the upper fragment projecting in the groin; but I cannot bring to my mind or find in my note-books a single well-marked case where the distortion could be attributed to such a cause. Circum¬ stances may conspire to produce it: the direction of the force, most probably when applied from behind; youth—for at this period when the bones yield they break more transversely than in after life;—such a sequence is most likely to disentangle the upper fragment, and leave it free to the action of the psoas and iliacus muscles. The second position to be considered in the case of Toole is in reference to the re-fracture of the bone. It has been already stated that the limb was useless in progression, being somewhat more than five inches shorter than the sound one. Thirty days had elapsed from the period of the accident, and the union was quite solid, sufficiently so to bear the weight of the body. The breaking of the callus in fractures badly consolidated is a very ancient practice, and highly extolled by many. And it was not until about the beginning of the last century that Petit and Heister so strongly objected to it, and Boyer and Callisen easily succeeded in causing it to be generally proscribed. Riche- rand, however, amongst the moderns, believed in its utility, but confines its application to cases where the deformity is exces¬ sive, and where it is urgently demanded by the patients. In Germany, however, we have very strong evidence in its favour. M. Oesterlen, in his endeavour to demonstrate the advantages of the rupture of the callus, has collected in his book several c 2$