The value of extension in the treatment of fractures of the femur / by John T. Hodgen.

  • Hodgen, John T. (John Thompson), 1826-1882.
Date:
1878
Catalogue details

Licence: Public Domain Mark

Credit: The value of extension in the treatment of fractures of the femur / by John T. Hodgen. 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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    above, with the intention of preventing retraction of the flaps and consequent protrusion of the bones. After a day or two, I have invariably found the flaps retracted, and the bones failed to protrude in those cases only in which the flaps were left so long that the usual retraction was not sufficient to draw the soft parts entirely beyond their ends. It will be remarked that surgeons in making amputations, with the probable retraction of flaps in view, make the flaps longer or shorter as the point of amputation varies from the point of origin of the muscles, which form a part ot the flap- With the hope of giving more uniform support to the flaps, I have, many times, applied plaster of Paris bandages to the stumps, embracing them up to the next joint; but I have invari- ably found after a day or two that the flaps were retracted within the plaster casing. In oblique fractures of the tibia, surgeons have in many cases found it impossible to prevent the rising end of a fragment from pressing dangerously on the skin of the shin, and the rising of the end is only one method of expressing muscular contraction, for the end is forced to rise by the lapping of the obliquely frac- tured bone at the site of fracture. I have been thus tedious in multiplying facts in regard to muscular contraction, not because there is a question concerning the contraction of muscles after fractures, but for the reason that some prominent members of the profession have given ut- terance to language which has been misunderstood, which has been supposed to express the thought that every fracture of the thigh could be so treated by plaster of Paris dressing as to pre- vent shortening. Let us for a moment consider the changes occurring in a fractured limb during the use of the long splint of Liston. Place the splint on the outer aspect of the limb, let it extend below the foot and above the hip, bind the limb and splint with the usual roller bandage, extend the muscles by such force as maj- be required to give the limb its proper length and allow the fragments to occupy their proper relations; now draw tight your well-padded perineal band and fix it so that it cannot loosen. You visit your patient on the second day to examine the dress- ings and find the perineal band is not tight, measure the limb and you find it shortened. Again extend the muscles, once more tighten the perineal band, and repeat this process every day or two for four, six, eight, or twelve weeks, and at the end of this * time it will be found that the perineal band has elongated, the tissues about the perineum, the prominence of the rounded thigh, the fulness of the outer part of the leg, the plumpness of the instep having atrophied, and through these changes, both in the extending apparatus and the tissues, the muscles have by their tonic contractile power shortened the limb. Follow another case : Put your patient on a firm table, place