125. I have little to add to the observations already made on the
prognosis in fractures of the condyls of the os humeri. All that I have
there said is applicable to the os femoris. As is the case with regard
to the former fractures, so also here, the apprehensions of authors
have been greatly exaggerated by their visionary doctrine respecting
injuries of the joints: both reason and experience unite in showing
such apprehensions to be unfounded.
I shall only observe, that in the present case, even more particularly
than in fractures of the condyls of the os humeri, most of the
unfortunate events that take place, are owing to the insufficiency of
the means employed for effecting a cure. Indeed, as I have already
observed (45), all those means can have no effect in opposing the
continual tendency of the fragments to become displaced, if the upper
fracture[29] of the os femoris be oblique. And in most cases, this
fracture is oblique: hence it follows, 1st, that the bony points of
the fragments being constantly pushed, during their displacement,
against the ligaments that surround the joint, will perpetuate in them
the irritation first produced by the fracture, and thus give rise to
swelling, inflammation, and all the other morbid affections of the
part, so much dreaded by authors, and attributed by them to the mere
communication of the fracture with the joint: 2dly, that the best
expedient to prevent such affections, is an apparatus that shall retain
the divided surfaces in perfect contact with each other by means of
permanent extension.
[29] That which forms the superior boundary of the longitudinal
fracture by which the condyls are separated from each other.
TRANS.
126. It is obvious that this extension will be less necessary, if the
upper division of the os femoris be transverse, because, then, the
condyls and the body of the bone will find a mutual point of support
against each other.
§ XXI.