Case of Ununited Fracture

J. H. Houghton
1850 BMJ (Clinical Research Edition)  
Let me, gentlemen, conclude my paper with a short account of Mr. B.'s case, as far as it relates to the question now under consideration; for him I devised my apparatus, and to him it was of so much service. Mr. B. was a gold merchant from the coast of Guinea; he was a man of colour. Ho was thrown from an omnibus in the Strand, and sustained a compound fracture of the left leg, in the latter part of December, 1 849. Mr. B. is a tall slim man, of delicate frame, about 48 years of age, and
more » ... of age, and healthy. The accident happened very near the hospital, and he was immediately brought into the house. It was then found that the left tibia was broken at the junction of the lower with the middle third, and the upper fragment, as is usual, was thrown forwards and overlapped the lower, and it protruded through the skin at least three inches. The laceration of the integument was not very great. The fibula was broken high up, and the fracture was simple. The patient being put to bed, the leg was placed in a Macintyre's splint, the parts having been previously restored, as nearly as possible, to their natural position. From that time till he left the hospital, this patient exhibited almost every kind of varied complication which can follow such an accident. It was just one of those difficult cases, which require so much skill in treatment on the part of the surgeon, and all that judgment and tact, which, I need scarcely tell you, it received at the hands of Mr. Partridge, under whose care Mr. B. was placed. The limb was at first kept in the Macintyre's splint; the wound poulticed twice daily, and sponged softly at each dressing. This was continued for three weeks, during which the patient progressed favourably. He now began to complain that hiis back felt tender from pressure upon the sacrum, and Mr. Partridge determined to use a swinging apparatus, and Torbock's was employed. The plan that was adopted was this ;-A splint was employed, consisting of the leg-piece and foot-piece of a Macintyre's splint, the thigh-piece and screw beneath for extension being removed, and the rest beneath the heel, for the support of the foot, was also cut off. This splint was padded with flannel, and covered with oil-silk. Previous to placing the leg in the splint, the limb at each dressing was raised, and well sponged on the under surface, dried, and then clothed with broad straps of lint, thickly spread with simple dressing, so as thoroughly to protect it; it was then carefully let down into the splint placed underneath for its reception, and fixed by stocking bandage at the foot and at the upper part of the leg, the wound being left bare for the poultice, which was changed twice daily. The leg was then swung. It was found that this mode of procedure answered well, excepting that the movement of the leg in the swing was very limited. There was the greatest difficulty with Torbeck's apparatus to employ any cradle to keep off the bed-clothes, and the adjustment of the cradle and bed-clothes pretty nearly prevented all motion of the leg, entangling and fixing the suspending chain which passed through tlhem. The apparatus before you was devised to obviate these difficulties. It is not my intention to enter minutely into the details of Mr. B.'s case: suffice it to say that he suffered severe complications. He was attacked repeatedly with erysipelas; he had several deep-seated abscesses in the leg and thigh. At one time there was enormous effusion into the knee-joint, and on three separate occasions considerable exfoliations took place from the tibia. Those of you who did not see him, must needs think how perilous was his condition, and will not wonder at the fear we entertained lest this lean wornout patient should suffer bed-sores; but from the cleanliness of the nurse, and the facility to cleanliness and change of posture which the swing afforded, this evil was warded off. It was with great satisfaction that I often witnessed the comfort and convenience that were afforded Mr. B. by the swing. I have frequently watched the manner in which he would assist himself; he would shift himself to one side of the bed, reach over and take up the pot de chambre, use it, resore it to its place, tand again get to the centre of the bed, with great alacrity, his broken leg swinging about under the cradle in accordance with the movements of his body, moving altogether and without concussion or injury, which could not have been effected without the swing. In the same way he would raise himself in bed and sit up, leaning his loins against the pillow unassisted, take his book from an adjacent table, or his paper and writing case and write. Again, any blow that struck the bed could produce no concussion of his leg, and any start he might make in his steep would not displace its parts. All swung easily and lightly and all moved together. Mr. B. remained in the hospital four months, and left it ultimately quite restored. .I must mention that my apparatus was manufactured by Mr. Matthews, Portugal Street, Lincoln's Inn, and it was well put out of hand, at a moderate charge.
doi:10.1136/bmj.s1-14.21.567 fatcat:xwlwmccdffd2pporn2wisitlfa