Surgery, Gynecology & Obstetrics Volume 14 (Paperback)

This historic book may have numerous typos and missing text. Purchasers can usually download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated. 1912 edition. Excerpt: ... the worst misfortune that can happen in operations for fractures. A beautiful illustration of the result of infection is shown in Figs. 3 and 4. This patient was admitted to the Presbyterian Hospital five days ago in extreme sepsis, with a history of operation for a fracture six weeks before.-The arm was a bag of pus which was draining imperfectly from a large sluggishly granulating wound. The white ends of the fragments could be seen in the wound. The radiograph (Fig. 3) showed very distinctly that the dead ends had separated, and with a little force they were pulled off the fragments. It is interesting to note that the line of separation formed at the holes that had been drilled through the fragments for the introduction of a suture. Infection must be eliminated if good results are to be expected, and if one cannot operate with absolute faith in his technique, he should not operate on fractures. It seems to me that the greatest improvement toward the avoidance of infection has come with the use of powerful forceps for controlling and reducing the fragments. In my hands they have shortened the time to about one-third of what used to be consumed in an operation. By their use reduction can be accomplished with far less injury to the soft parts; the fingers and hands do not have to be inserted into the wound, and plates and fragments are held absolutely fixed while the screws are introduced, thus causing every screw to have a similar bearing, and consequently all to hold in the same direction at once. It is a principle well known to all mechanics that to get the full holding benefit from screws the substances to be fastened together must be rigidly clamped in position when the screws are being introduced. If this is not done, the strain of...