Note 63 — PART SECOND. OF PARTICULAR SURGICAL SUBJECTS. (continued 12)
Reading edition
[A comparison of the results of the different kinds of treatment of disunited fracture, furnished by Dr. Norris of Philadelphia, in an able and elaborate article in the American Journal of the Medical Sciences, for January, 1842, leaves no doubt as to their relative value. Of forty-six cases in which the seton was employed, thirty-six were cured, three partially relieved, five not benefited, and two died. In twenty-one the seton was introduced with, and in twenty-four without, previous incision: of the former seventeen were cured, two improved, one failed, and one died; of the latter eighteen were cured, one was benefited, five failed, and one died. In reference to the seat of the fracture, the cases stand as follows:—
13for the femur,of which9were cured.
10”leg,”10”
16”humerus,”10”
6”forearm,”6”
1”jaw,”1”
The average period of the existence of the fracture in the above cases was nearly twelve months and a half, the longest ten years, the shortest six weeks. The mean period of the retention of the seton was seven weeks and three days. In one instance—that of a fractured humerus—it was left in thirteen months, notwithstanding which it finally failed. The average time required for the cure was nearly three months, the longest eight months, the shortest three weeks. Arterial hemorrhage occurred in two of the cases; in ten, severe fever, erysipelas, or profuse suppuration.
Of thirty-eight cases in which resection was performed, twenty-four were cured, one improved, seven failed, and six died. The seat of the injury was as follows:—
12were in thefemur,of which7were cured.
6”leg,”5”
12”humerus,”6”
7”forearm, ”5”and 1 improved.
1”jaw,”1”
The longest period of the existence of the fracture in these cases was five years, the shortest ten weeks, the average thirteen months and nineteen days. The average time required for effecting a cure was four months, the shortest one month, the longest thirteen months. In seventeen of the cases other methods of treatment had been ineffectually tried: in six the resection was followed by erysipelas, in one by phlegmasia dolens, and in two by profuse suppuration and abscesses.
Of thirty-six cases healed by pressure and rest, twenty-nine were cured, one improved, and six failed. The seat of fracture was:—
13cases in thefemur,of which 9were cured.
7”leg,”7”
12”humerus,”9”
4”forearm,”4”
The average duration of the fracture in the above cases was five months and twelve days, the longest twenty-two months, the shortest four weeks. The mean period required for a cure was nine weeks, the longest nine months, the shortest eighteen days. In one of the cases the treatment was productive of excoriations, in three of severe pain and inflammation.
Cauterization of the ends of the fragments, after free exposure of them by the knife, was successfully employed in six cases; in two others it completely failed. The article most frequently used was the caustic potash. Frictions succeeded in eleven cases.
From a careful analysis of all the circumstances connected with the preceding cases, one hundred and thirty-nine in number, and of which the above is an abstract, Dr. Norris has deduced the following conclusions:—1. That non-union after fracture is most common in the thigh and arm. 2. That the mortality after operations for its cure follows the same laws as after amputations and other great operations on the extremities, the danger being in proportion to the size of the limb and the proximity of the injury to the trunk. 3. That failures after operations are more frequent in the humerus than in other bones, and in middle-aged and elderly persons than in young ones. 4. That the seton, variously modified, is safer, speedier, and more successful than resection or caustic. 5. That incising the soft parts previously to introducing the seton augments the danger, but renders the cure more certain and expeditious. 6. That allowing the seton to remain in for a long time exposes to accidents, and does not facilitate the cure. 7. That the seton is least successful in the femur and humerus.—ED.]