36. The mere reduction of a fracture of the os femoris, is but one step
towards the cure. In this, more than in the fracture of any other bone,
causes which act incessantly (13) tend to subvert the momentary work of
art; it is here, then, in particular, that means ought to be devised
for maintaining this work. But, the first of these means is a suitable
position of the limb. I have already mentioned the inconveniences
that result, both as to the reduction and subsequent treatment, from
that proposed by Pott (24 ... 26). The patient must, then, be laid
horizontally on a plain exactly even, and not capable of being affected
or rendered uneven by the weight of the body. Instead of feather beds
generally used in other cases at the Hotel-Dieu, Desault, in cases of
fractures, substituted firm and hard mattresses, which, not sinking
in the least, by the pressure of the body, give no cause to apprehend
those continual displacements, to which a soft bed exposes the patient.
These mattresses supersede the advice of certain authors who direct a
plank to be placed under the patient.
37. The second means, not less efficacious than the first, consist
in the forms of apparatus, in which the limb is placed, and which,
being differently modified according to the fancies of their different
authors, present us with an assemblage of various splints, compresses,
&c. To appreciate, with accuracy and correctness, the advantage and
disadvantage of these, let us first unfold the curative indications
which they ought to fulfil; we will then compare their mode of
action with these indications, from whence will result, as necessary
inferences, the object of our research.
38. The intention of every form of apparatus being, to prevent the
displacement of the fragments, the causes of this displacement ought to
be the basis or foundation of its mechanism and construction. But these
causes in the present case are, 1st, the muscular action drawing the
inferior fragment upwards (10); 2dly, the weight of the body pushing
the superior fragment downwards (14); whence every form of apparatus
intended to keep the os femoris in place when fractured obliquely,
ought, 1st, to draw the lower fragment downward and retain it there;
2dly, to draw and retain upwards the superior fragment, and the trunk
which bears on its upper end. This principle is applicable generally,
and subject only to a few exceptions which I shall notice when treating
of transverse fractures, where the displacement is lateral, or in the
direction of the cross-diameter of the bone, or where no displacement
at all exists. 3dly, The apparatus must also be so constructed as to
prevent the rotatory motions of the lower fragment (18), and secure the
immobility of the limb, lest by means of some motion being communicated
to it, the fragments might be deranged.
§ VII.