PART IV. SPECIAL SUBJECTS. (Part 1)

PART IV. SPECIAL SUBJECTS. L\ II. Terms and Definitions 725 LMIl. The Use of the X-Ray. By H. G. Stover, M.D. . . . 735 LIX. The Open Treatment of Fractures 754 LX. Bone Transplantation 77 1 LXI. Treatment of Compound Fractures and Dislocations . 789 ILLUSTRATIONS. FIG. PAGE 1. Muscular and ligamentous attachments of clavicle 5 2. Superior surface of right clavicle 12 3. Inferior surface of right clavicle 12 4 and 5. Internal structure of right clavicle 12 0. Relation of brachial plexus to first rib and clavicle 13 7. Fracture of clavicle in child. Rontgenogram 13 8. Fracture of clavicle in its inner third. Rontgenogram .... 14 9. Greenstick fracture of clavicle. Rontgenogram 14 10. Fracture of middle of clavicle. Rontgenogram 15 11. Fracture of clavicle with usual deformity. Rontgenogram . . 15 12. Comminuted fracture of outer end of clavicle. Rontgenogram . 16 13. Comminuted fracture of clavicle. Rontgenogram 16 14. Fracture of right clavicle (recent). Photograph 17 15. Recent fracture of clavicle. Photograph 17 16. Side view of same case 17 17. Recent fracture of right clavicle. Photograph 18 18. Side view of same case 18 19. Fracture of clavicle 24 hours old. Photograph . . . . . .18 20. Side view of same case 18 21. Recent fracture of left clavicle. Photograph 19 22. Another view of same case 19 23. Delayed union of fractured clavicle. Photograph 19 24. Another view of same case 19 25. Fracture of clavicle in elderly woman. Photograph .... 20 26. Old fracture of clavicle with deformity. Photograph .... 20 27 and 28. Demonstrate the outlines of clavicles. Photographs . . 21 29. Recent fracture of right clavicle 23 30 to 33. Application of modified Sayre's dressing 24 34. Mohr's figure-of-eight 25 35. The application of Velpeau's bandage 25 36. Case showing result of recumbent treatment . 26 37 and 38. C. F. Taylor's brace 27 39. Dislocation of outer end of clavicle and separation of acromial epiphysis. Rontgenogram 31 40. Recent dislocation of outer end of clavicle. Photograph ... 32 41. Dislocation of outer end of clavicle. Photograph ..... 33 42. Lateral view of same case ; ... 33 43. Downward dislocation of outer end of clavicle. Photograph . . 34 44. Dressing for dislocation of outer end of clavicle 35 45. Same principle carried out with adhesive plaster 35 46. Ventral surface of right scapula 37 47. Dorsal surface of right scapula . 37 48. View of right scapula from axillary border 38 49. Fracture of neck of scapula. Rontgenogram 39 50. Palpation of scapula 41 51. Strapping of chest for fracture of scapula 42 52. Action of capsule in adduction of arm. Diagram 43 53. Action of capsule in abduction of arm. Diagram 43 54. Bones of normal shoulder 47 55. Subcoracoid dislocation 47 56. Intracoracoid or subclavicular dislocation 47 xiii XIV ILLUSTRATIONS FIG. PAGE 57. Intraclavicular dislocation with moderate deformity ..... 47 58. Subglenoid dislocation 48 59. Luxatio erecta 48 60. Subacromial dislocation of shoulder 48 61. Subspinous dislocation of shoulder 48 62. Low subcoracoid dislocation. Kontgenogram 50 63. Recent subcoracoid dislocation of left shoulder 52 64. Subcoracoid dislocation of left shoulder 53 65. Examination of same case showing depression below acromion . . 53 66. Recent subcoracoid dislocation of right shoulder 54 67. Another view of same case 54 68. Another view of same case 55 69. Recent subcoracoid dislocation of right shoulder 55 70. Another view of same case 55 71. Low subcoracoid dislocation of shoulder 56 72. Low subcoracoid dislocation of shoulder 56 73. Another view of same case 56 74. Palpating recent subglenoid dislocation of shoulder 57 75. Palpating recent subglenoid dislocation of shoulder 57 76. Retentive dressing for dislocation of shoulder 58 77. Recent typical subglenoid dislocation of left shoulder .... 59 78. Recent subcoracoid dislocation of left shoulder 59 79. Attitude of lea.st pain in subcoracoid dislocation 59 80. Attitude of least discomfort in subglenoid dislocation . . . .60 81. Another view of same case 60 &2. Luxatio erecta 61 83. Another view of same case 61 84. Posterior dislocation of right shoulder 62 85. Another view of same case. Palpation of head .62 86. Another view of same case 63 87. Case of avulsion of upper extremity 63 88. Subcoracoid dislocation in fleshy woman 64 89. Subcoracoid dislocation of shoulder in fleshy man 65 90. Subcoracoid dislocation of right shoulder 67 91. First step in Kocher's method 67 92. Second step in Kocher's method 67 93. Third step m Kocher's method 67 94. Illustrating principles of Kocher's method 68 95. McRurney's hook 72 96. Dislocation of shoulder complicated by fracture of anatomical neck of humerus 72 97. Rontgenogram of same case before operation .73 98. Rontgenogram of same case after operation 73 99. Same case after operation 74 100 and 101. Stereoscopic Rontgenogram of fracture and dislocation of shoulder 74 102. Subcoracoid dislocation with fracture of greater tuberosity . . 75 103 and 104. Contracture following dislocation of shoulder .... 76 105, 106 and 107. Old unreduced dislocation of shoulder .... 78 108. Recurrent dislocation of shoulder 79 109. Upper end of humerus- 83 110. Structure of upper end of humerus . . 83 111. Rontgenogram of upper end of humerus showing epiphyseal carti- lage 84 112. Rontgenogram of fracture of anatomical neck of humerus ... 85 113. Rontgenogram of fracture of surgical neck of humerus .... 86 114. Rontgenogram of comminuted fracture of surgical neck ... 87 115. Rontgenogram of fracture of surgical neck ! 68 116. Rontgenogram of fracture of surgical neck ! ! 89 117. Recent fracture of surgical neck of humerus .....!! 90 ILLUSTRATIONS XV FIG. PAGE 118. Another view of same case 90 119. Same case seen in recumbent position 90 120. Rontgenogram of fracture of surgical neck 91 121. Fracture of surgical neck of humerus 91 122. x\nother view of same case 92 123. Rontgenogram of same case ............ 93 124. Low fracture of surgical neck 93 125. Same case seen in recumbent position 94 126. Old fracture of surgical neck 94 127. Lateral view of same case 94 128. Rontgenogram of same case 95 129. Measuring length of humerus 96 130. Palpating humeral head during rotation 96 131. Palpating humeral head through axilla 96 132. Cigar-box boards used in making axillary pad 98 133. Axillary pad completed 99 134. 135 and 136. Three views of axillary pad in place ..... 99 137. Plaster shoulder cap 101 138. Axillary pad in position and arm bandaged 101 139. Same after the plaster shoulder cap has been applied . . , . 101 140. Body swathe used to secure arm to side and act as sling . . .101 141. Middledorf triangle .............. 102 142. Monks triangle 102 143. Osgood-Penhallow splint 102 144. Plaster cast applied with arm in abduction 104 145. Plaster cast applied with arm in abduction; forearm raised , . 104 146. Anterior surface of right humerus .......... 109 147. Posterior surface of right humerus . 109 148. Spiral, comminuted fracture of humerus. Rontgenogram . . .110 149. Fracture of humeral shaft. Rontgenogram . . . . . . ,110 150. Multiple fracture of humeral shaft. Rontgenogram . . . . . Ill 151. Oblique fracture of humeral shaft. Rontgenogram . . . , .111 152. Recent fracture of shaft of left humerus . . . . . . . .112 153. Crushing injury of arm. Fracture of humeral shaft . . . .112 154. Stromeyer cushion 114 155. Axillary pad in place and arm bandaged . . 114 156. Coaptation splints applied to arm 114 157. Body swathe applied 114 158. Rontgenogram of spiral fracture of humeral shaft . . . . .117 159. Same after operation and reduction with internal fixation . . .117 160. Rontgenogram of same case nine months later 118 161. 162 and 163. Photographs of bone (same case) showing result . 118 164, 165 and 166. Views of lower end of humerus 120 167 and 168. Rontgenogram of fracture of lower end of humerus . . 121 169 and 170. Rontgenogram of fracture of lower end of humerus . . 122 171 to 174. Rontgenogram of fracture of lower end of humerus . .123 175 to 178. Rontgenogram of fracture of lower end of humerus . . 124 179. Epiphyseal separation of epitrochlea. Rontgenogram .... 125 180. Lateral view of same case. Rontgenogram 125 181. Rontgenogram of fracture of internal epicondyle 126 182. Rontgenogram of epiphyseal separation of external condyle . . 126 183. Rontgenogram of epiphyseal separation of internal epicondyle . 126 1184. Recent fracture of external epicondyle with deformity . . . 129 185. Recent fracture of lower end of humerus 130 186. Another view of same case 130 187. Recent fracture of lower end of humerus. (Splitting.) . . . 130 188. Recent transverse fracture of lower end of hvimerus .... 132 189. Another view of same case in sitting position 132 190 and 191. Rontgenograms of same case 133 192. Recent compound comminuted fracture of lower end of humerus . 133 Xvi ILLUSTRATIONS FIG. P-^GE 193. Another view of same case 133 194. Recent compound comminuted fracture of lower end of humerus . 134 195. Another view of same case 134 196. Old gunstock deformity result of fracture above and below elbow . 135 197. Another view of sam.e case 135 198. Old case of diacondylar fracture of lower end of humerus . . . 136 199. Another view of same case 136 200. Examination of case in which carrying angle has been lost . .137 201. Examination of same case with elbows extended . . . . . .137 202. Examination of pronounced gunstock deformity in flexion . . . 138 203. Same case with elbow extended 138 204. Another view of same case 139 205. Old fracture of lower end of humerus with musculo-spiral paralysis 140 206. Another view of same case showing contracture 141 207. Same case seen from ulnar side of forearm 141 208. Case of cubitus varus in one arm and cubitus valgus in the other . 142 209. Pronounced normal carrying angle ... - 142 210. Dressing for treating arm with elbow in flexion 145 211. Dupuy internal right-angle splint 146 212. Dupuy external right-angle splint 146 213. Internal right-angle splint applied 14G 214. Internal right-angle splint with traction 146 215. Plaster splints for upper extremity 147 216 and 217. Adjustable splints for elbow 148 218. Splitting of lower end of humerus. Rontgenogram 149 219. Rontgenogram of same case live years after operation .... 149 220 and 221. Range of motion in elbow of same case five years after operation 150 222 and 223. Ligaments of elbow 154 224. Recent posterior dislocation of right elbow 157 225, 226 and 227. Additional views of same case . . . .157 and 158 228. Recent posterior dislocation of left elbow 159 229. Palpating head of radius and empty sigmoid in same case . . 159 230. Posterior view of same case 160 231. Lateral dislocation of elbow 160 232. Another view of same case 160 233. 234 and 235. Diagrammatic comparison of posterior dislocation of elbow, supracondylar and diacondylar fractures , . . . .163 236. Swelling of elbow following simple strain 164 237. Swelling of elbow 24 hours following dislocation 165 238. Another view of same case 165 239. Rontgenogram of forward dislocation of elbow with fracture of olecranon iq(] 240. Rontgenogram of fracture of coronoid complicating backward dis- location of elbow 16(5 241. Backward dislocation with fracture of tip of coronoid. Rontgeno- gram 167 242. Backward dislocation with comminuted fracture of coronoid proc- ess. Rontgenogram 167 243. Fracture of coronoid with displacement produced by backward dis- location of elbow. Rontgenogram 167 244. Fracture of coronoid with slight displacement. Rontgenogram . 167 245. Method of reducing backward dislocation of elbow . . . . . 168 246. Another method of reducing backward dislocation of elbow . . 168 247 and 24i8. Range of motion fourteen days following backward dislo- cation of elbow * 172 249. Forward dislocation of head of radius . .179 250 and 251. Rontgenograms of same case . . . . 170 252. Fracture of olecranon. Rontgenogram 186 253. Fracture of olecranon; elbow extended. Rontgenogram . . .187 ILLUSTRATIONS XVll FIG. PAGE 254. Same case: elbow slightly flexed. Rontgenogram 187 255. Fracture of olecranon one week following accident 189 256. Palpation of same case 189 257. The straight splint used in the treatment of fractures of the ole- cranon 191 258. Fracture of olecranon. Rontgenogram 193 259. Same case after operation with internal fixation . . . . , . 193 260. The use of passive motion following fracture of olecranon . . . 195 261. Fracture of head and neck of radius. Rontgenogram .... 197 262. Comminuted fracture of head of radius. Rontgenogram . . . 197 263. Fracture of head and neck of radius. Rontgenogram .... 198 264. Fracture of head of radius. Rontgenogram 199 265. Fracture of head of radius. Rontgenogram ....... 199 266 and 267. Gunstock deformity result of fracture of both bones of forearm just below elbow 201 268. Structure of radius 204 269. Structure of ulna 204 270. Recent fracture of both bones of forearm 206 271. Another view of same case 207 272 and 273. Rontgenograms of same case 207 274 and 275. Rontgenograms of same case after operation .... 208 276. Recent fracture of both bones of forearm 208 277. Recent fracture of both bones of the forearm 209 278. Another view of same case 209 279. Reduction of same case 210 280. Same case seen from ventral surface of forearm .210 281 and 282. Rontgenograms of same case after reduction .... 211 283 and 284. Same case seen after splints have been applied . . . .212 2185 and 286. Same case at time of removal of splints ..... 212 287 and 288. Fracture of radial shaft 213 289 and 290. Opposite arm of same case examined for comparison . . 213 291 and 292. Rontgenograms of same case taken after reduction . .214 293 and 294. Rontgenograms of same case taken after second reduction 214 295 and 296. Rontgenograms of same case taken after operation and in- ternal fixation 215 297. Fracture of both bones of forearm with unusual deformity . .215 298 and 299. Two views of recent fracture of both bones of the forearm 216 300. Recent fracture of both bones of the forearm near wrist . . .216 301 and 302. Recent fracture of both bones of the forearm near wrist with slight deformity 217 303. Fracture of radius and free radial styloid. Rontgenogram . . 217 304 and 305. Rontgenogram of green-stick fracture of ulna .... 218 306. Testing lateral spring in bones of forearm 220 307. Recent fracture of both bones of forearm 223 308. Same case. Deformity corrected and anterior splint applied . . 223 309. Same case showing "cut-out" in ventral splint 223 310. Same case. Dorsal splint applied 223 311. Splints bandaged 223 312. Removal of dorsal splint for inspection 224 313 and 314. Rontgenograms of fracture of both bones of forearm with overriding deformity 227 315 and 316. Rontgenograms of same case after operation and internal fixation 227 317. Slight bowing of bones of forearm following imperfect reduction . 229 318, 319 and 320. Volkmann's contracture 230 321. Fracture of both bones of the forearm and separation of lower ulnar epiphysis 233 322 and 323. Rontgenograms of same case 233 324. Fracture and separation of lower ulnar epiphysis 234 325. Backward dislocation of lower end of ulna 238 Xviii ILLUSTRATIONS FIG ^^^^ 326, 327, 328, 329, 330 and 331. Rontgenograms of different types of fracture of lower end of radius 243 332, 333, 334. Rontgenograms of "Reversed Colles' " . . . . . • -^ 244 335 and 336. Fracture of lower end of radius produced by "auto-kick." Rontgenogram 244 337, 338 and 339. RontgenogTams of Colles' transverse Colles' fracture ^ with impaction 245 340. Fracture of lower end of radius produced by auto-kick. Rontgeno- gram • 246 341 and 342. Lateral and antero-posterior views of Colles' fracture witli slight deformity. Rontgenograms 247 343. Rontgenogram of comminuted Colles' fracture. Rontgenogram . 247 344 and 345. Rotgenogram of transverse Colles' fracture with impaction 248 346 and 347. RontgenogTams of oblique Colles' fracture 248 348 and 349. Rontgenograms of separation of lower radial epiphysis complicated by fracture 249 350 and 351. Separation and fracture of lower radial epiphysis . . 250 352 and 353. Separation and fracture of lower radial epiphysis . . 250 354. Recent typical Colles' fracture 252 355. Recent Colles' fracture 252 356. Recent Colles' fracture showing radial displacement of hand . . 253 357 and 358. Tavo views of recent Colles' fracture 253 359. Recent Colles' fracture showing displacement of articular surface 254 360 and 361. Two views of recent Colles' fracture ...... 254 362 and 363. Two views of recent Colles' fracture 255 364 and 365. Two views of recent Colles' fracture 255 366 and 367. Two views of recent oblique Colles' fracture .... 256 368 and 369. Two views of separation of lower radial epiphysis . . 258 370. Another view of same case 259 371. Recent epiphyseal separation of lower end of radius .... 259 372. Same case immediately following reduction ....... 259 373. Radial view of recent Colles' fracture • 261 374. Ulnar view of recent Colles' fracture 261 375. Same case. Ventral view 261 376. Same case. Comparison of levels of two styloids 261 377. Same case. Comparison of levels of two styloids 261 378 and 379. Photographic comparison of Colles' fracture and backward dislocation of wrist 262 380 and 381. Radial and ulnar views of recent Colles' fracture . . . 263 382 and 383. Same case showing two methods of reducing Colles' frac- ture 264 384. Diagrams illustrating principles involved in reducing Colles' frac- ture ....... 264 3185. Flat ventral splint 265