On a new method of managing fractures : from the address in surgery, delivered at the Twentieth Anniversary Meeting of the Provincial Medical and Surgical Association, held at Oxford, on Wednesday and Thursday, July 21st and 22nd, 1852 / by James Torry Hester, fellow of the Royal College of Surgeons, surgeon to the Radcliffe Infirmary, Oxford.

  • Hester, James Torry
Date:
1853
Catalogue details

Licence: Public Domain Mark

Credit: On a new method of managing fractures : from the address in surgery, delivered at the Twentieth Anniversary Meeting of the Provincial Medical and Surgical Association, held at Oxford, on Wednesday and Thursday, July 21st and 22nd, 1852 / by James Torry Hester, fellow of the Royal College of Surgeons, surgeon to the Radcliffe Infirmary, Oxford. Source: Wellcome Collection.

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    relaxes all the muscles surrounding the broken bone, &c.” “ Apply,” says be, “ the same reasoning to the os femoris, that bone whose fracture so often lames the patient, and disgraces the surgeon. “ Will it not be more cogent and more conclusive, in proportion as the muscles in connexion with this bone are more numerous and stronger ? I would ask any man who is conversant with accidents of this kind, what is the posture which almost every person whose os femoris has been newly broken puts himself into, in order to obtain ease, until he gets proper assistance ? Do such people stretch out their limb and place their leg and thigh straight, resting on the calf and heel ? I believe seldom or never. On the contrary, do not such people always bend their knee, and lay the broken thigh on the outside ? And is not the reason why this must be the most easy posture obvious ?” I would ask, moreover, what is the position which most people assume when they lie in bed without a broken bone ? Do they not generally hex the thigh on the trunk, and the leg on the thigh ? The reason is clear; it is the most comfortable position. In the straight position, however, provided the fracture be in the middle of the bone, you may generally expect to get a very good and serviceable limb, provided the splint be well applied, and the case carefully attended to : but, should the fracture be the upper- third of the bone, the result will not always be so satisfactory. The psoas magnus and iliacus internus have a tendency to elevate the bone and rotate it out, whilst the other large muscles arising from the pelvis, and attached to the outer part of the femur, tend to abduct it. Thus, though the limb may not be shortened, the ends of the bone will not be in a good state of apposition. In fractures near the knee, it is, I think, likewise objectionable; for when the limb is placed in a straight position, the gastrocnemius, acting strongly, has a tendency to draw the bone down, and thus to produce a degree of deformity causing the upper part to project. I have recently had a case in which this occurred. The fracture was so near the knee joint that it was very doubtful whether it did not extend into it, and from the swelling which had taken place, an accurate examination could nor be made. As it appeared probable that a stiff joint might result, I placed it in a straight position, but on examining it when the swelling had subsided, which was not for some time, the upper part of the bone was found