A treatise on fractures in the vicinity of the joints, and on certain forms of accidental and congenital dislocations.

  • Smith, Robert William.
Date:
1850
Catalogue details

Licence: Public Domain Mark

Credit: A treatise on fractures in the vicinity of the joints, and on certain forms of accidental and congenital dislocations. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    fragment extended in one situation a little external to the capsule; this portion was not united.* The preceding cases furnish ample evidence of the possibility of the occurrence of osseous union in cases of intracapsular frac- ture of the neck of the femur, and it is highly probable that they have all been examples of impacted fractures : certainly in all those, of which delineations have been given, there has been either penetration of one fragment by a portion of the other, or else the irregularity of the line of fracture has been such that the displacement of the fragments has been prevented ; they have been maintained in contact and at rest, and it is under such cir- cumstances alone that we are to hope for the occurrence of bony consolidation. Our prognosis, in cases of fracture of the neck of the femur, must always be unfavourable; in many instances the injury soon proves fatal, and in all the functions of the limb are for ever impaired; no matter whether the fracture has taken place within or external to the capsule, whether it has united by ligament or bone, shortening of the limb and lameness are the inevitable results. In forming our prognosis, we must take into account principally the age of the patient, and the situation and nature of the fracture. The results of my own experience would lead me to say, that the form of fracture which is most rapidly and most frequently fatal, is the extracapsular fracture, when it is accompanied by a comminuted fracture with displacement of the trochanters ; but as regards the functions and utility of the limb during the remainder of the patient's life, the intracapsular fracture is the more serious acci- dent, for, independent of the difference which exists between these two varieties of the fracture, as regards the possibility of the occurrence of osseous union, there is likewise a remarkable dif- ference with respect to the ultimate shortening of the limb; for in the extracapsular fracture the amount of shortening which took place when the injury occurred seldom subsequently undergoes any very material increase, but when the fracture is seated within the capsule, absorption of the neck of the bone slowly but steadily proceeds, and an amount of shortening of the limb is thus ulti- * Amesbury on Fractures, vol. i.