OCR Text |
Show .v-.-r Av;-..- .. .75'.‘-<;.. -.~, .. Tu i, . 11:2 {an in. Mad. must be classed under this head. In fracture of the spine too there is more danger from the injury to the spinal marrow, than from the fracture of the bone ; and in fracture of the rib, with injury of the lungs, the importance of the case rests chiefly on the latter circumstance. The danger and all the circumstances of the cases now enumerated being peculiar, they may be ranked under the class of complicated fracture. Fractures of the skull form a subject quite distinct, on account of the peculiarity of symptoms, and the treatment tonbe followed, the whole case coming under the influence of a very :cliiierent. principle from that which regulates the practice in cases of the fracture of other bones. \Vhen, in consequence of a fall, the limb is distorted, and i evidently fractured, the greatest precaution should be used in replacing it in its natural position, and the patient ought not to be moved from the place until such temporary support be given to the limb, that he may be carried without pain or farther injury from the motion and twisting of the shattered ends of the bones. When a surgeon is sent for to an accident of this nature, t t' 113 the movement of the limb. In feeling the part, we continue to trace some projecting spine (as of the tibia or ulna), the bet ter to ascertain the displacement of the bones. But this being insufficient fully to inform us of the nature of the accident, we must take the whole limb in our hands, or make a careful as sistant do this while we have our hands surrounding the inj ured part, or, should it be an injury of the chest, we place the hand bread on the side, while the patient breathes. In performing this necessary office, I need not say that the bone is insensible in its natural state, and before inflammation has arisen, and that the pain occasioned by the accident is owing to the injury of the. soft parts : the pain of the opera: tion is merely that of the repeated injury of the surrounding parts by the ends of the bones; so that every unnecessary motion is to be guarded against. But it is of more import- ance to say that, in the first examination of a limb, we ought to be fully satisfied so as to leave no doubt of the nature of the accident, for if we cannot ascertain the nature and extent of the injury at first, we shall be less able to do so when the swelling and inflammation have advanced; and when that swelling and pain have subsided, the time for remedying the another surgeon being expected, he ought to wait before he distortion is past; we have lost an opportunity not to be re- examines the limb, that they may together observe the motions and feeling of the limb without occasioning any unnecessary pain. But if the accident be recent, and the swelling coming on, the surgeon ought not to lose the favourable opportunity for examining the position of the bones and the joints. "'hen gained. Where great arteries or nerves run close upon the fracture, {as in fracture of the thigh bone a little below its middle), we must be particularly careful how we move the bone; for by incautiously twisting it, or by the rough carriage of the iimb, the artery may be torn upon the sharp ends of the the swelling and inflammation have arisen, such examination bone. will often be found impracticable. If a surgeon come to the side of a patient in this situation, or perhaps after the limb has been dressed, he cannot make the due examination, and ought not to hazard an opinion. The bone is ascertained to be fractured by the unnatural It may in general be said that, in distinguishing fracture irom dislocation, there is in fracture less distortion, and 105:; position of the limb, the hand or foot being generally twisted, or having fallen down ; by the harsh grating feeling commu- rigidity of the muscles and tendons, with greater pliancy in the limbs ; and that though there is pain, there is yet tree motion when the surgeon moves the limb ; while in disloration there is a checked and interrupted motion. The mere fracture of the bone would in no instance require nicated to the finger, when placed on the injured part, during attention to the system, or any general treatment ; but the . [~W‘v‘ "I?" '"UW‘ ,'-'¢\-n ,. r-a- .. l‘ T0 DISTWGUISH FRACTURE FROM DISLOCATION. '10 msrincmsn rnacrnnn mom DISLUCATION. , vet. Ii. ,, |