File:A practical treatise on fractures and dislocations (1912) (14598311837).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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3 personal cases and collects 46. In 1 heobtained an excellent result; and Skillora and Pancoast (Annals ofSurgery, 1912, Iv. 92) briefly report 1 recent and 3 old cases, withskiagrams. 3. TRANSVERSE FRACTURE OF THE SACRUM. This rare injury is produced by blows or falls upon the correspond-ing region, and appears in all cases to have occupied the lower half ofthe bone and to have been produced by the forcible bending inward ofits apex. Its direction is practically transverse. Malgaigne hasreported one case of oblique fracture; in it the violence was receivedupon the side of the bone, and there were also two incomplete trans-verse fractures. The usual displacement is an angular one, the coccyx and lower frag-ment being drawn forward so that the apex of the angle is directedbackward at the seat of fracture. The displacement is due in part tothe fracturing force and in part to the action of the attached muscles.In a case that came under my observation at Bellevue Hospital there PLATE XXI
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Fracture of Acetabulum and Displacen^ent ol Fe miir inwa ^ FRACTURES OF THE PELVIS. 345 was extensive sloughing over the sacrum and denudation of the bone,apparently due to the direct violence that caused the fracture. Thesame complication is mentioned in two of the five cases collected byMalgaigne, both terminating fatally. The symptoms are : pain at the seat of fracture, both spontaneous andprovoked by pressure or movements of the trunk, or by the act of defe-cation, or perhaps by the act of coughing; the displacement if present;and abnormal mobility and crepitus recognized by grasping the lowerfragment between the thumb and a finger introduced into the rectum. Agnew^ says ^ there will probably be present paralysis of the blad-der and rectum, both of these organs receiving nerves from the sacralplexus/ and Lossen ^ says that when there is complete displacement ofthe fragment paralysis of the lower extremities, bladder, and rectumis never absent, but neither author quotes any cases i

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