THE MODERN TREATMENT OF
FRACTURES. In
few,
if any,
there been
so
departments of surgery lias important an advance of late years,
in the treatment of fractures.
as
Complete
immobilisation have given place to the judicious use of massage, and early movement of the injured limb. Prior to the introduc-
and
prolonged
tion of the modern method of treatment, the orthodox procedure consisted in fixing the limb in some rigid apparatus, in which it remained
imprisoned weeks.
period varying from five to six said to depend upon a was of rigidity in the apparatus, degree for
a
Success
maximum and
a minimum amount of interference 011 the of the surgeon. Even in the latest edition part when of Esmarch's surgery, we are told that the less once a fractured limb has been put up "
it is disturbed the better. No good can possibly come from meddling with it." It is true that a few surgeons, amongst whom was the late Mr. of
Spence, recognised passive
movement
that
was
a
certain amount
necessary to prevent d
294
THE INDIAN MEDICAL GAZETTE.
and adhesions of tendons, but even those who advocated this treatment, did not consider it justifiable to commence such move-
thickening
ments until
an
advanced
in the treatment
period
of the case; four weeks for of the forearm.
example
in the
of inflammatory effusion is a few
commenced within of the The
principles
treatment
That the results obtained by this old method of treatment are often very unsatisfactory is admitted by all. In many cases after the splints have been removed, farther and prolonged treatment by passive movements, friction, and douches is required, before the functions
set at rest
are
restored to
healthy
a
state.
In
of workmen and others dependent on their own exertions, for the support of themselves and their families, the necessity for such
the
case
treatment is a grave matter, and any will curtail this period of enforcewhich method be welcomed by all surgeons. must ed idleness
prolonged
remember the time when sprains, ?like fractures were treated by prolonged rest. It was only the triumphs of bone-setters over Most of
orthodox
us
practitioners that ultimately drove adopt a more rational method of
surgeons to treatment. The
change
the method of
in
and cannot be said the
approbation
ever
slowly even
yet
of the entire
that may be,
ever
treating fracsprains,
than that of to
have
received
profession.
since the
new
How-
method of
dealing with fractures by means of massage, and passive movements was so strongly advocated by Lucas Championierre, a few years ao-o, this treatment has been carried out by a great number of surgeons, all cf whom have reported well of the method. It was formerly laid down as necessary in the of the limbs that the case of many fractures and below the seat above joints immediately of fracture should be fixed in such a manner that
movement
of these
joints could be the whole period of treatment The result of this procedure was to produce no
carried
out
during
many instances, great stiffness, more especially in those cases in which the fracture was to one of the joints. The fate of in in
proximity
the muscles was still worse than that of the became in all cases disabled joints, for the former of result matting together by inflamas the
matory effusion, and by wasting from pressure and disuse. Under the new method of treatment, stiffness of the
passive
joints
is
prevented by early rapid absorption
movements, whilst the
promoted by massage days of the receipt
which underlie this method of
sound, that they are not liable to be challenged seriously by any one. The only questions which have arisen are, firstly, whether such treatment is likely to interfere with the process of union, and secondly, the applicability of the procedure to all varieties are so
of fracture.
by
The first of these doubts has been So far from
the results of practice.
union the method, if efficiently carried to hasten consolidation of the callus, and to promote bony union of the fragments. As
hindering out, tend-s
the second question experience has shown that there are few, if any, fractures in which this
regards
treatment cannot be carried out without
although according
the
procedure requires
benefit,
to be modified
to the circumstances of each
In case. of transverse fracture, or others, in which there is little or no tendency to displacement, once reduction has been effected, passive movecases
be commenced within a few days receipt of injury; but in those cases in
ments may
of the
tures has come more
1898.
injury.
case
of the limb
[August
which
is
the
a
difficulty fragments in
to be deferred to
a
experienced position, the
later
in
maintaining
treatment has
period^ Massage,
on
the
may be commenced almost at once in all cases. During the first weelc it may be practised without removing the splints over other
that
hand,
portion
of the limb
which remains
un-
covered. The practice of early massage not only produces the results mentioned above, but also relieves pain, and the sensation of tension in the pare. Excellent as this method appears to be, it requires to be carried out with care and
intelligence. Unless can be secured, this
attempted.
these essential conditions treatment should not be
FRACTURES. In
few,
if any,
there been
so
departments of surgery lias important an advance of late years,
in the treatment of fractures.
as
Complete
immobilisation have given place to the judicious use of massage, and early movement of the injured limb. Prior to the introduc-
and
prolonged
tion of the modern method of treatment, the orthodox procedure consisted in fixing the limb in some rigid apparatus, in which it remained
imprisoned weeks.
period varying from five to six said to depend upon a was of rigidity in the apparatus, degree for
a
Success
maximum and
a minimum amount of interference 011 the of the surgeon. Even in the latest edition part when of Esmarch's surgery, we are told that the less once a fractured limb has been put up "
it is disturbed the better. No good can possibly come from meddling with it." It is true that a few surgeons, amongst whom was the late Mr. of
Spence, recognised passive
movement
that
was
a
certain amount
necessary to prevent d
294
THE INDIAN MEDICAL GAZETTE.
and adhesions of tendons, but even those who advocated this treatment, did not consider it justifiable to commence such move-
thickening
ments until
an
advanced
in the treatment
period
of the case; four weeks for of the forearm.
example
in the
of inflammatory effusion is a few
commenced within of the The
principles
treatment
That the results obtained by this old method of treatment are often very unsatisfactory is admitted by all. In many cases after the splints have been removed, farther and prolonged treatment by passive movements, friction, and douches is required, before the functions
set at rest
are
restored to
healthy
a
state.
In
of workmen and others dependent on their own exertions, for the support of themselves and their families, the necessity for such
the
case
treatment is a grave matter, and any will curtail this period of enforcewhich method be welcomed by all surgeons. must ed idleness
prolonged
remember the time when sprains, ?like fractures were treated by prolonged rest. It was only the triumphs of bone-setters over Most of
orthodox
us
practitioners that ultimately drove adopt a more rational method of
surgeons to treatment. The
change
the method of
in
and cannot be said the
approbation
ever
slowly even
yet
of the entire
that may be,
ever
treating fracsprains,
than that of to
have
received
profession.
since the
new
How-
method of
dealing with fractures by means of massage, and passive movements was so strongly advocated by Lucas Championierre, a few years ao-o, this treatment has been carried out by a great number of surgeons, all cf whom have reported well of the method. It was formerly laid down as necessary in the of the limbs that the case of many fractures and below the seat above joints immediately of fracture should be fixed in such a manner that
movement
of these
joints could be the whole period of treatment The result of this procedure was to produce no
carried
out
during
many instances, great stiffness, more especially in those cases in which the fracture was to one of the joints. The fate of in in
proximity
the muscles was still worse than that of the became in all cases disabled joints, for the former of result matting together by inflamas the
matory effusion, and by wasting from pressure and disuse. Under the new method of treatment, stiffness of the
passive
joints
is
prevented by early rapid absorption
movements, whilst the
promoted by massage days of the receipt
which underlie this method of
sound, that they are not liable to be challenged seriously by any one. The only questions which have arisen are, firstly, whether such treatment is likely to interfere with the process of union, and secondly, the applicability of the procedure to all varieties are so
of fracture.
by
The first of these doubts has been So far from
the results of practice.
union the method, if efficiently carried to hasten consolidation of the callus, and to promote bony union of the fragments. As
hindering out, tend-s
the second question experience has shown that there are few, if any, fractures in which this
regards
treatment cannot be carried out without
although according
the
procedure requires
benefit,
to be modified
to the circumstances of each
In case. of transverse fracture, or others, in which there is little or no tendency to displacement, once reduction has been effected, passive movecases
be commenced within a few days receipt of injury; but in those cases in
ments may
of the
tures has come more
1898.
injury.
case
of the limb
[August
which
is
the
a
difficulty fragments in
to be deferred to
a
experienced position, the
later
in
maintaining
treatment has
period^ Massage,
on
the
may be commenced almost at once in all cases. During the first weelc it may be practised without removing the splints over other
that
hand,
portion
of the limb
which remains
un-
covered. The practice of early massage not only produces the results mentioned above, but also relieves pain, and the sensation of tension in the pare. Excellent as this method appears to be, it requires to be carried out with care and
intelligence. Unless can be secured, this
attempted.
these essential conditions treatment should not be
