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第11章

on fractures-第11章

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straight line。 And one may use with advantage in this form of
dislocation the method of extension formerly described; for the
application of the bandages in the case of fracture of the arm; but
when extension is made; the parts are to be adjusted; as has been also
described above。
  43。 But if the arm be dislocated backward (but this very rarely
happens; and it is the most painful of all; and the most subject to
bilious fevers of the continual type; which prove fatal in the
course of a few days); in such a case the patient cannot extend the
arm。 If you are quickly present; by forcible extension the parts may
return to their place of their own accord; but if fever have
previously come on; you must no longer attempt reduction; for the pain
will be rendered more intense by any such violent attempt。 In a
word; no joint whatever should be reduced during the prevalence of
fever; and least of all the elbow…joint。
  44。 There are also other troublesome injuries connected with the
elbow…joint; for example; the thicker bone (radius?) is sometime
partially displaced from the other; and the patient can neither
perform extension nor flexion properly。 This accident becomes
obvious upon examination with the hand at the bend of the arm near the
division of the vein that runs up the muscle。 In such a case it is not
easy to reduce the parts to their natural state; nor is it easy; in
the separation of any two bones united by symphysis; to restore them
to their natural state; for there will necessarily be a swelling at
the seat of the diastasis。 The method of bandaging a joint has been
already described in treating of the application of bandages to the
ankle。
  45。 In certain cases the process of the ulna (olecranon?) behind the
humerus is broken; sometimes its cartilaginous part; which gives
origin to the posterior tendon of the arm; and sometimes its fore
part; at the base of the anterior coronoid process; and when this
displacement takes place; it is apt to be attended with malignant
fever。 The joint; however; remains in place; for its whole base
protrudes at that point。 But when the displacement takes place where
its head overtops the arm; the joint becomes looser if the bone be
fairly broken across。 To speak in general terms; all cases of
fractured bones are less dangerous than those in which the bones are
not broken; but the veins and important nerves (tendons?) situated
in these places are contused; for the risk of death is more
immediate in the latter class of cases than in the former; if
continual fever come on。 But fractures of this nature seldom occur。
  46。 It sometimes happens that the head of the humerus is fractured
at its epiphysis; and this; although it may appear to be a much more
troublesome accident; is in fact a much milder one than the other
injuries at the joint。
  47。 The treatment especially befitting each particular dislocation
has been described; and it has been laid down as a rule; that
immediate reduction is of the utmost advantage; owing to the rapid
manner in which inflammation of the tendons supervenes。 For even
when the luxated parts are immediately reduced; the tendons usually
become stiffened; and for a considerable time prevent extension and
flexion from being performed to the ordinary extent。 are to be treated
in a similar way; whether the extremity of the articulating bone be
snapped off; whether the bones be separated; or whether they be
dislocated; for they are all to be treated with plenty of bandages;
compresses; and cerate; like other fractures。 The position of the
joint in all these cases should be the same; as when a fractured arm
or fore…arm has been bound up。 For this is the most common position in
all dislocations; displacements; and fractures; and it is the most
convenient for the subsequent movements; whether of extension or
flexion; as being the intermediate stage between both。 And this is the
position in which the patient can most conveniently carry or suspend
his arm in a sling。 And besides; if the joint is to be stiffened by
callus; it were better that this should not take place when the arm is
extended; for this position will be a great impediment and little
advantage; if the arm be wholly bent; it will be more useful; but it
will be much more convenient to have the joint in the intermediate
position when it becomes ankylosed。 So much with regard to position。
  48。 In bandaging; the head of the first bandage should be placed
at the seat of the injury; whether it be a case of fracture; of
dislocation; or of diastasis (separation?); and the first turns should
be made there; and the bandages should be applied most firmly at
that place; and less so on either side。 The bandaging should
comprehend both the arm and the fore…arm; and on both should be to a
much greater extent than most physicians apply it; so that the
swelling may be expelled from the seat of the injury to either side。
And point of the fore…arm should be comprehended in the bandaging;
whether the injury be in that place or not; in order that the swelling
may not collect there。 In applying bandages; we must avoid as much
as possible accumulating many turns of the bandage at the bend of
the arm。 For the principal compression should be at the seat of the
injury; and the same rules are to be observed; and at the same
periods; with regard to compression and relaxation; as formerly
described respecting the treatment of broken bones; and the bandages
should be renewed every third day; and they should appear loose on the
third day; as in the other case。 And splints should be applied at
the proper time (for there is nothing unsuitable in them; whether
the bones be fractured or not; provided there is no fever); they
should be particularly loose; whether applied to the arm or the
forearm; but they must not be thick。 It is necessary that they
should be of unequal size; and that the one should ride over the
other; whenever from the flexion it is judged proper。 And the
application of the compresses should be regulated in the same manner
as has been stated with regard to the splints; and they should be
put on in a somewhat more bulky form at the seat of the injury。 The
periods are to be estimated from the inflammation; and from what has
been written on them above。




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