Prof. Helferich (Archiv. f. Klinische Chirurgie, Band 36, 4. Heft,
1888). In cases of delayed union, and even in normal cases, to hasten
the natural process of repair, H. advises the application of an elastic
rubber bandage in such a manner as to retard the return flow of venous
blood, by this means favoring an increased amount of pabulum to the
field of repair, thus indirectly augmenting the formation of callus. The
patient must be taught to regulate the pressure, attention being
directed to the condition of the nails, in order that the bandage may be
adjusted to suit the varying condition of congestion present. Œdema may
be controlled by the application of a flannel bandage to that portion of
the limb below the site of fracture. It is claimed that by this method
the cure, in normal cases even, is considerably shortened. The process
of repair is hastened by keeping the limb in a dependent position. The
presence of small erosions at the site of fracture is not a
contra-indication to the use of the elastic band. The time of
application is of some importance, a too early application leading to
too active hyperæmia; while, on the other hand, if too long delayed, the
period of time in which the action will take place has passed. In wired
compound fractures and in resections, pressure may be applied in from
five to fourteen days after the operation, providing inflammatory
symptoms are absent.
Thomas, of Liverpool, has recommended a procedure, which is known as the
percussion method, to hasten the repair in delayed bony union, in cases
of imperfect union, and in ununited fractures. This consists of
percussing, once in a day or two, the site of the injury with a small
copper hammer for five minutes or more, and subsequently bandaging the
parts firmly.
It is suggested that the formation of varicose veins may be an objection
to the method of Helferich. Further, it is quite clear that the method
is not to be thought of in tuberculous subjects, as well as in cases of
large open wounds at the site of fracture, or where a gap is left by
resection of bone, removal of tumors, etc. The question of its
applicability to atrophic members is an open one.