8. The preceding assemblage of signs, leaves in general but little
doubt on the subject of the diagnosis; but is the establishment of a
solid prognosis attended with the same facility?
If authors be consulted, they will be all found to agree, in
considering the communication of fractures with a joint as a
complication of a very serious nature. A swelling of the adjacent
parts, their inflammation, a continuance of the pains after the
reduction, extensive abscesses, a gangrene even of the soft parts,
and a caries of the bones; such, according to these authors, are
the almost inevitable consequences of these kinds of fractures, of
which an anchylosis is the most favourable termination that can be
expected. Petit, Heister, and Duverney, do not describe the evils that
accompany these accidents. Pare, in speaking of them, says, “In such
cases, the violence done to the tendons generally gives rise to great
inflammation.”
9. From whence can arise these exaggerated fears? Can it be, as is
pretended, the mere communication of the fracture with a joint, that is
productive of such serious affections? What relation, then, can reason
discover between the cause and the effect? Does not experience answer
in other cases, in a manner that admits of no reply, when it furnishes
us with the analogy of fractures of the rotula, the olecranon, &c.?
Modern researches have entirely abolished the ancient theory of an
effusion of callus into the joint, and with it one of the principal
causes assigned by writers for the accidents and evils which they so
much dreaded.
The admission of air into an articular cavity, would be, without doubt,
in such cases, a consideration of more weight; but this does not occur
except in fractures accompanied with wounds, and yet all those in the
vicinity of joints, whether compound of not, are regarded as extremely
dangerous. Besides, observation has oftentimes proven to Desault, that
even the contact of air is not so dangerous as it has been commonly
supposed, and many instances occurred to him in his practice, where,
notwithstanding such a complication, a perfect cure was obtained.
10. It is, then, to the want of a skilful mode of treatment, and
to the irritation experienced in the parts, in consequence of an
ill-constructed apparatus being applied to them, that the accidents
formerly mentioned (8) ought to be attributed. Such accidents never
occurred to Desault, in any of the numerous cases that fell under
his care. It is thus that in the fracture of the neck of the os
femoris, the insufficiency of the means, is oftentimes productive of
unfavourable results.
§ III.