Primary amputation of the upper extremity rarely to be practiced for
musket-shot wounds, or for injuries of the soft parts; treatment of
slight gunshot wounds of the head of the humerus; a depending opening
for the exit of matter to be made, if not previously existing; the
principal points to attend to in such cases; simple incised wounds
of the joint; splintering of the head of the bone, or the passage of
a ball through it, requires its being sawn off; cases for amputation
of the arm; site of the operation, the head of the bone being
uninjured; complete shattering of the arm; complicated with more
or less severe injury of the chest or abdomen; if the latter not
likely to cause a speedy dissolution, then amputation of the arm is
to be performed; moderate hemorrhage or expectoration of blood, under
such circumstances, not absolutely fatal; destructive injuries from
rebounding or nearly spent round shot, or flat pieces of shell, without
external signs of a wound; necessity for an immediate operation in such
cases; amputation at the shoulder-joint; the fear of hemorrhage passed
away; compression of the subclavian; amputation at the shoulder-joint
for malignant disease of the bone and periosteum; the acromion and
coracoid processes should not be exposed, nor is it necessary to
deprive the glenoid cavity of its cartilage; the nerves to be cut
short, after the operation has been completed, else they may cause
distressing pain for life; primary amputation at the shoulder-joint
a very simple operation; secondary amputation much less so; general
directions prior to the operation; the operation by two flaps, external
and internal; by one, or nearly one, upper flap; Lisfranc’s operation;
modification of it by M. Baudens; difficulties of the secondary
amputation; amputation of the arm immediately below the tuberosities
of the humerus; excision of the head of the humerus; Langenbeck’s
operation; this excision not easy of execution when the head and neck
of the bone are broken from the shaft, nor in secondary operations:
not to be practiced in every instance of compound fracture of the
part; cases; injury of the head of the humerus, with much loss of the
soft parts; giving way of the axillary artery during the treatment
not a cause for amputation; the vessel to be tied above and below the
opening, and the subclavian not to be ligatured till all other means
have failed; amputation of the arm by the circular incision; cases
requiring this operation; Mr. Luke’s operation by two flaps; excision
of the elbow-joint; injuries of the joint not requiring this operation;
cases in which it is admissible; mode of operating; amputation at the
elbow-joint recommended, but not often performed; mode of operating;
supposed advantage attending the retention of the olecranon; amputation
of the forearm; seldom requisite; the flap operation preferable,
particularly near the wrist; mode of operating; the circular operation
in the middle of the forearm; amputation at the wrist; in all injuries
of the hand, requiring an operation, the thumb and one or more fingers
to be preserved, if possible; treatment of metacarpal bones fractured
by a musket-ball; of injured metacarpal bones, the fingers being
destroyed; removal of the heads of the metacarpal bones when necessary;
amputation of the phalanges; Langenbeck’s operation for excision of
the phalangeal joints; excision of the metacarpal bone of the thumb
by Langenbeck, the periosteum being separated from the bone, and left
behind in the wound. pp. 120-141.