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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    the horizontal posture allows of more shrinkage, and the exten- sion not being accurately retained necessitates the more frequent change of the dressings.” I can understand that the erect posture would allow an increased quantity of blood to flow into a pendant limb, and that the returning flow would be retarded, and that the plaster case would now be filled and kept full by the cedematous limb, but I •cannot understand how the tissues at the points at which exten- sion and counter-extension are made and kept so tightly filled with blood and serum as to make adequate extension on the limb. We may be told that the weight of the limb is to act as the extending force, and I am ready to admit that this would be sufficient, yet it is impossible to keep the patient erect during the entire six, eight or twelve weeks required for the accomplish- ment of firm union. If the patient be kept walking about the room for six hours in the twenty-four, it is quite as much as the most vigorous man could accomplish with a fractured thigh. The change of posture twice in twenty-four hours will imply the application of extension six hours, and its entire absence eighteen hours of the twenty-four. The proposition is too absurd to deserve serious consideration. I do not wish to be understood as regarding lateral supports as valueless, but I do assert that lateral supports are of value in the treatment of fractures only so far as they aid in preventing angular deformity, and in transverse fractures aid as extending agents only by keeping the ends of the fractured bones opposite each other, and thus enable the bones themselves to resist the contraction of the muicles. Having thus far considered the inefficiency of lateral supports only as used alone in the treatment of fractures of the thigh, and the impossibility of maintaining continuous extension by any of the so-called fixed apparatuses, I come now to consider directly the value of continuous extension in the treatment of fractures of the femur. By continuous extension I mean the employment of a force that does not vary in power. To have continuous extension we must use a force that is unvarying, and apply that force so that it may not be modified by friction. Elastic extension cannot be unvarying from the very charac- ter of the material used. The Aveight and pulley as used by Hildanus and modified by Buck must vary in its action because of friction. Oblique sus- pension is the only possible way in which unvarying extension can be applied, and this is absolutely unvarying, pro Added the angle is constantly maintained and the Aveight of the suspended limb does not change. The muscles that tend to produce a shortening in oblique fractures of the thigh, during the period of union of the frac- tures, when the ends of the bones are softened by nutritive