On an improved method of treatment of separation of the lower epiphysis of the femur / by J. Hutchinson, jun. and H.L. Barnard.

  • Hutchinson, Jonathan, 1859-1933.
Date:
[1899]
Catalogue details

Licence: Public Domain Mark

Credit: On an improved method of treatment of separation of the lower epiphysis of the femur / by J. Hutchinson, jun. and H.L. Barnard. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    fortnight, when it became necessary to amputate the limb, after which operation the boy recovered. It was found that the projecting diaphysis had torn open the popliteal vein, and that much haemorrhage had occurred. Further, there was an abscess in the wall of the popliteal artery. Such a case, where one or both main vessels in the popliteal space are seriously damaged by the projecting diaphysis, is probably doomed to amputation from the first, and it is to be feared that this will, with rare excep- tions, in spite of the advance of surgery, remain true for long. But one must discriminate, and we believe the prognosis would be less grave than has been just stated if two simple rules were observed in the treatment of these cases. Before giving them we shall be excused for dwelling on a few preliminary points. First, as regards the gravity of compound separation of the lower femoral epiphysis the following figures ^ will convince anyone that it has not been exaggerated. Out of thirty cases collected the result was— Death from shock . . . . .4 (13%) Primary amputation, of which at least 3 cases died . 13 (43% ) The diaphysial end was resected and reduction thus secured—all recovered with useful but somewhat short- ened limbs . . . . . .5 (17%) Reduction was more or less effected without resection ; of these 3 died from pyaemia, 4 required subsequent ampu- tation, and one only recovered, retaining his limb after prolonged suppuration and necrosis . . .8 (27%) Thus, out of the total of thirty cases, ten at least proved fatal (^. e. no less than 33 per cent.), whilst of the re- mainder fourteen recovered only at the cost of the limb (in one case amputated at the hip-joint), and only six (20 per cent.) recovered without this mutilation. Is there any other compound fracture of similar fre- quency in which such depressing results follow the sur- * <1. Hutchinson, inn., ‘ Injuries to the Epiphyses,’ Jacksonian Prize Essay, R.C.S. See also ‘ Brit. Med. Journ.,’ 1894.