Report of clinical cases treated during the session 1859-60 in the surgical wards of the Royal Infirmary under the care of James Spence.

Date:
1861
Catalogue details

Licence: Public Domain Mark

Credit: Report of clinical cases treated during the session 1859-60 in the surgical wards of the Royal Infirmary under the care of James Spence. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    As to the plans of treatment adopted in the simple fractures of the lower extremities which are mentioned, I have not thought it necessary to detail them. I may, however, state them here gene- rally. In cases of fracture of the shaft of the femur, I employ the long splint, together with two short splints, fixed with slip knots on each side of the broken bone, to prevent any lateral displacement. In fractures of the neck of the femur, the long splint, without the lateral support, is used; but in many cases of old infirm persons, in whom the use of the splint cannot be continued, I have recourse to the following plan.—A long narrow pillow or pad is placed between the legs, extending from above the knee to below the ankle, and the injured limb is secured to the sound one, by bandages at the knees and ankles, a broad flannel spica bandage being applied round the pelvis, and over the upper part of the injured thigh, so as to fix the thigh and pelvis. I prefer this plan to the double incline of pillows, as it not only ensures greater fixity and extension, but also enables us to place the patient occasionally on the sound side, and so diminish the risk of bed-sores forming on the back. In cases where, from extensive bruising of the body or limb on the injured side, or other causes preventing the use of the splint, and where, at the same time, full extension is desirable, I apply the long splint on the sound limb, and then keep the injured limb fully extended, by fastening it to the sound one thus fixed. In cases of simple fracture of the bones of the leg, I find the simplest and most satisfactory plan is the use of two lateral paste- board splints with foot-pieces, moulded to the limb, secured by slip knots, the limb being laid on the outer side, and flexed to a greater or less degree, according to the nature of the fracture. In cases of very oblique comminuted or compound fractures, or in cases of fracture of the tibia very high up, the use of Liston’s splint, properly padded and adjusted, is the treatment I resort to. In fractures near the malleoli, attended with splitting of the lower part of the tibia, or separation of that bone from the fibula, in which the heel and foot are retracted, and the bones of the leg projected, and where the tendency to retraction, recurring after coaptation, is considerable, the stirrup splint well padded and placed on the front of the leg (used either alone or combined with narrow lateral splints), affords a fixed point to which we can bring forward the heel by bandaging, whilst, at the same time, it presses upon the bones of the leg^and prevents them projecting forwards. In cases of Pott’s fracture of the fibula above the malleolus, attended with eversion and twisting of the foot, Dupuytren’s splint, applied along the tibial side of the leg, is used as a fulcrum over which the foot is kept inverted, whilst, at the same time, slight extension is preserved. For some cases attended with retraction of the foot as well as eversion, the stirrup splint may be used with advantage, the inner horn of the stirrup being made the fulcrum over which the foot is kept inverted, whilst retraction is obviated by bandaging the heel forwards to the splint.