Old unreduced dislocations : read at the Fifty-fifth Annual Session of the American Medical Association, in the Section on Surgery and Anatomy, and approved for publication by the Executive Committee, Drs. DeForest Willard, Charles A. Powers and J.E. Moore / De Forest Willard.

  • Willard, De Forest, 1846-1910.
Date:
1904
Catalogue details

Licence: In copyright

Credit: Old unreduced dislocations : read at the Fifty-fifth Annual Session of the American Medical Association, in the Section on Surgery and Anatomy, and approved for publication by the Executive Committee, Drs. DeForest Willard, Charles A. Powers and J.E. Moore / De Forest Willard. 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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    ting off a large portion of tlie innervation of the del- toid. It affords easy access to the glenoid, but not to the head. Even with the anterior incision there will be some atrophy of the internal fibers of the deltoid, but this loss is partially compensated by the pectoral. The old operation of ciitting off the attachment of the del- toid is a bad one. If the biceps tendon is torn or cut, it should be restitched. In excisions it is better to take away too much rather than too little. Hemorrhage is greatly lessened by closely hugging the bone with bone gouge or chisel. It is sometimes necessary to divide the tendons of the infraspinatus and supraspinatus, the long head of the biceps, subscapularis and teres minor. After freeing the tissues about the head and neck 'of femur or humerus, I have sometimes had the greatest difficulty in replacement and have been obliged to divide all the tis- sues most freely. In some cases traction on the head may be made through the incision by placing a curved bone, elevator or strong wire about the head, b_y using a lever, or by drilling the bone and inserting strong steel hooks. When the glenoid cavity is filled with a tough cicatricial fibrous mass, the socket must be cleared with gouge and knife. In tlie young, great care should be taken not to injure the epiphysis, and resection should not be employed except under special circumstances. The natural accommodative mobility of the scapula must be taken into account, and the amount of adhesions. The subsequent fixation and pain depend largely on the original injury and the position of the head. In resec- tions the keyhole saw or the heavy chain saw is advisa- ble. Owing to the liability of breakage, I have had a chain saw made from an old ecraseur. When old dislo- cation and fracture coexist, the question of manipula- tion or arthrotomy or excision is a serious one. The broken fragment may have united to the bone in bad position, or it may have become thoroughly adherent to surrounding tissues, or it may be entirely disconnected. Fragments may be nailed or wired in position. Ee-