American practice of surgery; a complete system of the science and art of surgery (1906) (14767894601)

Identifier: americanpractic02brya (find matches)

Title: American practice of surgery ; a complete system of the science and art of surgery

Year: 1906 (1900s)

Authors: Bryant, Joseph D. (Joseph Decatur), 1845-1914, ed Buck, Albert H. (Albert Henry), 1842-1922

Subjects: Surgery

Publisher: New York, W. Wood and company

Contributing Library: Columbia University Libraries

Digitizing Sponsor: Open Knowledge Commons

Text Appearing Before Image:

for conservative treat-ment, and this is particularly true of those resultmg from rifle bullets. Eventhough all the bones entering uito the formation of the joint are fractured, anattempt should be made to save the limb, unless there is accompanying exten-sive destruction of the soft parts and laceration of the main vessels and nerves.The aim of conservaiive treatment should be not only to save the limb, but to ob-tain a movable joint. Unfortunately, this ideal result cannot always be obtained.Ankylosis is almost sure to occm- in cases in which the opposing bones of a joint 748 AMERICAN PRACTICE OF SURGERY. are fractured, but some motion of pronation and supination may be retainedwhen the head of the radius has escaped injury. Unfortunately, the cases inwhich movable joints are obtained are rare, but, unless the amount of conmiinu-tion of the bones is extensive or the wound infected, the surgeon should exhaustevery means to prevent ankylosis, as by the early use of passive motion and

Text Appearing After Image:

Fig. 212.—Fracture of Arm from a Revolver Bullet (.45 Calibre). Skiagraph showing mucltcamminution of the bone and involvement of the joint, with lodgment of jaieces of missile. Conserva-tive treatment. Recovery with movable joint. (Spanish-American war case.) massage. Even in infected wounds, our modern methods of antisepsis may bedepended upon to limit or reduce the inflammatory processes. The conserva-tive treatment of wounds of the elbow joint, like those of the shoulder, consistsin exploration of the wound, whenever necessary, together with the removal ofall loose bone fragments and the replacing of those not entirely detached. Hav-ing in mind the probability of ankylosis, the surgeon should flex the forearm ata right angle with the arm and place the hand in a position midway between GUNSHOT WOUNDS. 749 pronation and supination, so that, if ankylosis docs occur, the elbow will be fixedin its most serviceable position. Where the wound is not infected, passivemotion should be ins

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1906

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