New Method of Treating Simple Transverse Fracture of the Patella
American Journal of the Medical Sciences
the eczema and excoriation caused through the constant soiling of the bandages by excretions, and to the great labour attending frequent renewal of the bandages, especially when it is necessary, as in fracture through the upper third of the femur, to include the pelvis, there is the further evil of enforced frequent move¬ ment of the injured part, through which movement consolidation is retarded, and dislocation and shortening of the fractured extremity rendered probable results. In this method
... lts. In this method of treatment, a long continuous band of plaster is fixed to both sides of the injured limb, as high as the seat of fracture, and applied so as to form a free loop below the sole. This long strip is then secured in the ordinary way by circular strips of plaster and by circular turns of a bandage. The leg, having been elevated, is then kept in the vertical position, with the corresponding side of the pelvis suspended, by means of a piece of cord fixed to the loop of plaster, and either attached above to some object over the bed or slung over a pulley, with its free extremity supporting a weight. The fragments of the broken bone then fall into proper position, and remain so, if the extension be maintained until firm union is established. The little patients, it is stated, tolerate this treatment very well, and at once cease to suffer from pain in the injured thigh. Vertical exten¬ sion does not necessitate constant and complete rest on the back ; but Dr, Kummcll docs not insist on this as one of the advantages of the method, as he is opposed to the view held by many surgeons, that prolonged rest on the hack is dangerous with young patients, and that it causes pulmonary affections and dis¬ turbance of the general health. Rotatory displacement of the fragments is not to be feared as a result of vertical extension, in most of the eases observed by Dr. Seliede and the author, callus has formed rapidly and in abundance; and in healthy children, it is asserted, consolidation of the fragments is usually well established by the end of the third week, when the bandage and strapping may be removed and the limb lowered. The usual result of this treatment is stated to he speedy and firm union, without displacement, and without any shortening of the injured limb. One disadvantage is mentioned as likely to occur in female infants subjected to this mode of treating fractured thigh. As a consequence of free entrance of air into the gaping ostium vagina.1 , the little patient may sutler from severe vaginal catarrh, which condition will persist as long' as the vertical extension is kept up, hut subsequently may he soon removed by careful cleansing and the local application of weak astringents. A tabular statement is appended of twenty-eight eases of fractured thigh in infants treated by this method. Of these patients, twelve were under twelve months of age, and sixteen between the ages of one and two years.--London Medical Record, April 15, 1S82.