_An account of Dr. Physick’s improvement of Desault’s apparatus for
making permanent extension in oblique fractures of the os femoris._
Dr. Physick having observed that in the application of Desault’s
apparatus, the patient was sometimes injured by the pressure of the
strap or roller _g g_ (plate 2) which passes under the tuberosity of
the ischium for the purpose of making counter-extension, devised the
following method of remedying this inconvenience, in which he succeeded
to his wishes.
He directed the upper end of the long external splint to be formed like
the head of a crutch, and the splint itself to be lengthened so as to
reach and bear against the axilla of the affected side, which must
be well defended from pressure by a bolster of flannel or some other
soft material. By this expedient the Dr. evidently formed two points
of counter-extension, instead of one, as is the case in the apparatus
of Desault. Between these two points, namely, the axilla and the
perineum, the same quantity and force of pressure is, by Dr. Physick’s
improvement, _divided_, which, in the original apparatus of Desault, is
borne by the _perineum alone_. The risque of excoriation and injury to
the patient, then, in the former case, is to that which he runs in the
latter, only as one to two, or nearly so. As it is no less the duty of
the surgeon to prevent suffering than it is to remove deformity or to
save life, Dr. Physick has certainly in this respect made an important
step in the advancement of his profession.
But there is still another advantage derived from the lengthening of
the external splint. In the original apparatus of Desault, the strap
_gg_ intended for counter-extension, by passing no higher up than the
spine of the ilium, runs too much across, and therefore acts too much
on, the upper part of the thigh. By this it not only irritates the
muscles of the part, and induces them to contract, but also tends to
draw the upper fragment of the os femoris a little outward, and thus to
render the thigh in some measure deformed. But, in the improvement of
Dr. Physick, the strap _gg_ is secured in a mortise cut in the external
splint, about midway between the spine of the ilium and the axilla.
This strap, by being thus carried higher up on the body, does not run
across the thigh at all. It consequently presses on and irritates the
muscles much less, acts more in the direction of the os femoris, and
has no tendency to draw the superior fragment outward.
Hence this improvement not only diminishes the patient’s sufferings,
but gives him, perhaps, the best possible chance of having his limb
preserved free from deformity.
[Illustration: _Plate 3._
_Fig. 1._
_Fig. 2._
_Fig. 3._
_Hooker delt._
_Tanner, Sc._]
Another improvement made on the lower end of the external splint by Dr.
James Hutchinson deserves also to be mentioned. It was found that in
the original apparatus of Desault, the strap or roller L (plate 2)
used for the purpose of extension, had a tendency to draw the foot too
much outward. This fault Dr. Hutchinson very ingeniously remedied, by
attaching to the lower part of the external splint, a little above the
mortise, a small block extending inwardly, at a right angle with the
splint, so far as to be on a line with the middle of the sole of the
foot. Over the end of this block, in which a notch is cut to receive
them, the ends of the strap L are carried, previously to their being
secured to the external splint. By means of this expedient extension is
made precisely in the direction of the limb, and the inconvenience of
drawing the foot outward is completely obviated.
Thus improved by Drs. Physick and Hutchinson, the apparatus of Desault
for oblique fractures of the os femoris, leaves, perhaps, scarcely a
remaining desideratum on the subject.