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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