On the treatment of fractures of the femur by a simple modification of Liston's splint : with observations on re-fracture of the bone in cases of deformity / by Richard G. H. Butcher.

  • Butcher, Richard G. H., 1819-1891.
Date:
1853
Catalogue details

Licence: Public Domain Mark

Credit: On the treatment of fractures of the femur by a simple modification of Liston's splint : with observations on re-fracture of the bone in cases of deformity / by Richard G. H. Butcher. Source: Wellcome Collection.

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    a pad, softly filled with a like material, and covered with cha¬ mois leather. The application of the apparatus, modified as I have de¬ scribed, is almost exactly in accordance with the directions given by Liston,—the screw and transverse piece of wood being detached, the splint is applied nearly in a similar manner; there are, however, some cautions to be observed in its adjustment which he has not adverted to, yet a strict observance of which I consider absolutely essential, that the same satisfactory results may be obtained as followed in the embarrassing cases that I have detailed. First, as to the preparation of the splint, and the guarding of the ankle from pressure. It has been stated that the splint is perforated, and has, adapted to the aperture, a soft chamois cushion; that a suitable pad extends along its inner surface, with a similar opening for the reception of the outer malleolus; but this not enough; there is also an additional pad, of varia¬ ble thickness, required to lie between the outer surface of the knee and the padded splint; or, in other words, to fill up the space between them occasioned by the natural obliquity of the thigh bone, this, of course, from the breadth of the pelvis, greater in women than in men. The next point is, that the limb should be drawn down to its full length, the broken bones coapted and retained so by assistants, the ankle, heel, and dor¬ sum of the foot rolled with soft wadding, the depression above the outer malleolus obliterated by additional folds of it, and the entire supported with a roller neatly applied from the toes to above the knee; then the ankle may be lashed to the splint, the surgeon taking good care that the turns of the bandage be even above the ankle, and secure the heel closely to the splint; if this be correctly done, eversion of the foot will be prevented. The ankle being thus fixed, and extension at the same time fully kept up, the perineal band is to be applied ; this lac must be made of soft material and well stuffed, at the same time that a strong piece of tape is stitched along its entire extent, from one end to the other, to prevent its yielding ; in its application care should be taken that it lies evenly up against the ramus of the ischium and pubis, that when the ends are brought through the holes at the upper part of the splint to be tied, tliey may be drawn on with an equal force ; because otherwise the integu¬ ments will be wrinkled, and quickly excite much irritation. Until the lac is tied the required extension should be kept up by an assistant at the ankle, so as to obviate the reprehensible practice of thrusting the splint with the lower part of the limb downwards; for if this manoeuvre be employed, the folds of