The Treatment of Compound Fractures by Modern Methods
HERBERT L. BURRELL, EDWIN W. DWIGHT
Boston Medical and Surgical Journal
DuiUNO the past few years the treatment of compound fractures has undergone radical changes and Ularked improvement. In this paper we shall confine ourselves to a consideration of the treatment of fractures of the thigh, leg, arm and fore-arm. The improvement in the results has been brought about by two causes. (1) Thorough exploration andcleansiiigof the wound, and antisepsis. (2) By the recognition of the importance of the physiological principle of complete rest to a fractured bone. It is of
... paseing interest to consider what results were obtained iu the treatment of compound fractures by the older methods. In Guy'a Hoapital from 1841 to 1801, twenty years, there was a mortality of about 28 per cent.; in the Pennsylvania Hospital from 1839 to 1851, twelve years, there waa a mortality of 44 per cent. ; in the New York Hospital during a similar period there was a mortality of 48 per cent. ; in the Obuchow Hospital Report of St. Petersburg there was a mortality of 08 per cent.2 Under modern methods Dennis reports one thousand oases of compound fractures, and after removing from consideration such cases as he feels justified in eliminating, he has remaining 081 cases of compound fractures, with one death from sepsis, giving a death rate of oneseventh of one per cent. In the mortality there has been such a noticeable decrease that it demands careful attention. It will be of interest to consider tho subject of compound fractures from the following standpoints : (1) The class of case that can be saved with a useful leg, aud the class of case that requires amputation. (2) The detail of "putting up" a compound fracture. (3) The management of a compound fracture. (4) The prognoaia. (1) The class of cases that can be saved with a useful leg, and the class of cases that require amputation. A primary amputation for a compound fracture at the Boston City Hospital is extremely rare; a few years ago it was common. Limbs which would foruierly have been unhesitatingly removed are now saved. to define percisely what should govern one in the imputation of a leg is extremely difficult ; but we take 'uto consideration the following factors: . a. The ago of the patient. Old age by no means indicates amputation. b. The physical condition of the patient in regard to alcoholism, renal trouble, etc. c. The patient's environment. d. The attention that he will receive in the aftertreatment of his case. c The facilities for " putting up" his leg autiaeptically and iu plaster. f The condition of the soft parts, bones, arteries, veins and nerves.