Ununited fractures in children / by D'Arcy Power.

  • Power, D'Arcy, 1855-1941.
Date:
1892
Catalogue details

Licence: Public Domain Mark

Credit: Ununited fractures in children / by D'Arcy Power. 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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    necessary in a fracture occurring in an adult, and especially during the second week. A fat child who is confined to bed, or whose movements are restrained, wastes very rapidly, so that bandages or plaster-of-Paris cases, which were at first quite sufficient to render the fragments immoveable, very soon require readjustment. This readjustment, however, must be done with discretion, since there is nothing so fatal to the satisfactory repair of a fracture as constant and needless meddling with the retentive apparatus. In some cases, too, it would seem as if the surgeon went to the opposite extreme, and simply left the fracture to take care of itself; this mistake is most commonly made in con- nection with a broken collar-bone, and is, perhaps, one of the reasons why so many instances of non-union are recorded in this bone. Such an error in treatment is also made when a green-stick fracture of the humerus, of the radius, or of the ulna is treated by the simple application of a sling. The child is taken home, allowed to crawl about, and the green- stick fracture is very probably converted into an ordinary fracture before the surgeon again sees it. Professor Agnew1 points out that in children the line of fracture is more often transverse than in adults. This point, if true, is of great interest, for it is obvious that it is much more difficult to keep the two ends of a transverse fracture in apposition, than one in which the fracture is oblique. In a transverse fracture the ends would either meet or they would not meet, whilst in an oblique one some part of the ends would be sure to overlap. The treatment of fractures in children, then, resolves itself into the following common sense rules:—Diagnose the fracture as early as possible, and in every case keep the fragments in perfect apposition. After the fragments have been secured, see that the apposition is maintained by exer- cising careful supervision, and, when necessary, by the 1 Op. cit., vol. i., p. 946.