File:American practice of surgery; a complete system of the science and art of surgery (1906) (14767896161).jpg

Identifier: americanpractic02brya (find matches)
Title: American practice of surgery ; a complete system of the science and art of surgery
Year: 1906 (1900s)
Authors: Bryant, Joseph D. (Joseph Decatur), 1845-1914, ed Buck, Albert H. (Albert Henry), 1842-1922
Subjects: Surgery
Publisher: New York, W. Wood and company
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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stifiable under aseptic technique to exploreall of these wounds and remove or replace the fragments. Without such explora-tion ankylosis almost invariably occurs, while by operating the surgeon may putthe parts in a more favorable condition. This method of treatment should cer-tainly be practised in all cases of comparatively large wounds and where thebones are considerably shattered. Following such injury there is always oblit-eration of the synovial sacs and binding together of the numerous tendons whichare in such close relation with the wrist joint. The small size of the bones ofthe wrist and the hand cause them to be greatly fragmented when struck by abullet, and, from the close proximity of the tendons and the tendon sheaths,bone fragments are driven into or against the latter and a large callus involvingthe tendons or interfering with their free movement is produced. Only by earlyoperation and thorough removal of these fragments can such result be obviated.. GUNSHOT WOUNDS. 751
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Fig. 213.—Pistol (.38 Calibre) Wound of the Hand. Skiagraph showing characteristic destructionof the shaft and shortening of the metacarpal bones, with lodgments of fragments of bullet. 752 AMERICAN PRACTICE OF SURGERY. Excision of the ivrist is rarely performed as an early operation. The resultof such operation has usually been no better than that obtained through con-servatism. Late excision may be practised where there is necrosis of the bones with con-tinued suppuration, or where there is ankylosis of the wrist bones with littleinvolvement of the tendons. In such cases operation by the Lister methodmay be followed by an excellent result. In suppurative cases firm union at thewrist and the mobility of the thumb and finger joints may be obtained. Inuninfected cases where the injury is entirely confined to the wrist articulation,a clean excision may give a partially movable wrist, provided passive motion^nd massage are early instituted and persistently carried out. Gunshot Wounds o

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