File:A practical treatise on fractures and dislocations (1912) (14598072978).jpg

Identifier: practicalt00stim (find matches)
Title: A practical treatise on fractures and dislocations
Year: 1912 (1910s)
Authors: Stimson, Lewis Atterbury, 1844-1917
Subjects: Fractures Dislocations
Publisher: New York, Philadelphia, Lea & Febiger
Contributing Library: The Library of Congress
Digitizing Sponsor: The Library of Congress

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he pin passes to the fracture. A ligature thrown circularly or, better^ obliquely in notches, aboutthe bone has been employed. Fixation by a bone pin inserted lengthwise into the medullary canalhas been practised, but mainly, I think, in operations after failure ofunion. It appears of late (1911) to have been rather freely used inSweden in fresh cases. In fracture of the patella, in which a special indication for fixationexists, ample support can be given by catgut sutures in-the fibro-periosteal covering of the front of the bone and in the lateral expan-sions close beside the bone, or even by a long mediate suture crossingthe front of the bone and embracing the tendon above and the ligamen-tum patellae below. The exposure and handling necessary for drilling thebone are thus avoided, with consequent diminution of risk. Somewhatsimilar methods can be used in fracture of the olecranon when the indi-cation exists. ^ Lane: Surgery, Gynsecology, and Obst., 1909, vol. viii. p. 344. PLATE IV
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Lanes Plate, Five Months after Applioati^ni. Absorption of Bone;Loosening of Seiwvs; Failin-e of Union. TREATMENT. 109 To sum it up, direct fixation is very rarely necessary ; when it ismade convenient by an existing wound it should be temporary, by theuse either of an absorbable suture or of one that can be easily removedafter a few days. Pins reaching to the exterior are also objectionablebecause of the difficulty of keeping their track aseptic; the infectionmay spread to the fracture. During the last few years a decided impetus has been given to themethod of treatment of simple fractures by incision and direct fixation.This impetus has come largely through the example and teaching ofMr. Arbuthnot Lane. He employs a modification of the metal braceapplied to the side of the bone, using long plates of steel attached tothe two fragQients by short, full-threaded screws, thus obtaining a fixa-tion sufficient to withstand a very considerable force. His reports ofcases indicate that interr

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