A contribution to the surgery of fractures and dislocations of the upper extremity : based upon an analysis of about seven hundred consecutive cases observed at the Manchester Royal Infirmary / by J. E. Platt.

  • Platt, J. E.
Date:
1899
Catalogue details

Licence: Public Domain Mark

Credit: A contribution to the surgery of fractures and dislocations of the upper extremity : based upon an analysis of about seven hundred consecutive cases observed at the Manchester Royal Infirmary / by J. E. Platt. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    admlniBtered, with the object of attempting reduction, before the patient came to the Infirmary. After renewed attempts had failed, an incision was made on the palmar aspect. The head of the metacarpal bone protruded through the muscles. Reduc- tion was efifected by passing the blade of a raspatory over the metacarpal head and under tlie base of the first phalanx, and levering the bone into place. The chief obstacle to reduction seemed to be the outer sesamoid bone, although I think It probable that the glenoid ligament also contributed. About three weeks later, when the patient was last seen, he was quite well, with the exception that the joint-movements were not fully restored. Dislocation of the first phalanx of the thumb may take place either forwards or backwards, the latter being much more frequently met mth. Either the forward or the backward dislocation may be com- plete or incomplete. Vitrac' describes two varieties of complete dorsal disloeation. He says that in almost afl cases the phalanx is turned slightly inwards as well as drawn backwards, but that there is a rare variety in which it is turned somewhat outwards, and which may result from violence when the thumb is in an extended and abducted position. Dislocation backwards is usually caused by a fall or blow upon the palmar surface of the thumb. The rarer foi-ward dislocation is due to violence received upon the dorsal surface. Eeduction of the displacement frequently offers no special diflfi- culties. In other cases, however, the difficulties are great, and may be quite insuperable without a resort to operative measures. • Very many explanations have been given of the cause of the difficulty. The locking of the head of the metacarpal bone between the lateral ligaments of the joint or between the two parts of the flexor brevis pollicis, the interposition of a sesamoid bone or a portion of the capsule between the joint-surfaces, and displacement of the flexor longus pollicis tendon have been given as the tnie causes. There can, however, be little doubt that the coiTect explanar tion is the way in which the metacarpal head is driven through the anterior ligament of the joint. Mr. J. Hutchinson, junr.', says that this ligament is rerj strong at its attachment to the phalanx, but near its attachment to the metacarpal bone it is much weaker, and consequently offers little resistance to the escape of the head of the latter bone, when the joint is forcibly extended. It is probable that in some cases the long flexor tendon also aids in preventing reduction. The various methods of attempting reduction in these cases need not be described, but a few remai-ks may be made about tlie mode of procedure in difficult cases. The giving of an anaesthetic alone is useless, since the obstacle to reduction is not muscular action. More- over, in these days of antiseptic surgci*y, the dislocation should never be allowed to remain unreduced. The choice of an operation lies