On rupture of the popliteal artery and popliteal aneurism / by Alfred Poland.

  • Poland, Alfred, 1822-1872.
Date:
[1860?]
Catalogue details

Licence: Public Domain Mark

Credit: On rupture of the popliteal artery and popliteal aneurism / by Alfred Poland. Source: Wellcome Collection.

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    down upon the vessel, and tied the two lacerated ends; but when the limb came to be examined (as amputation had to be performed afterwards), it was found that the injury had been caused by a dislocation of the knee, and the kick could not have produced such an amount of injury; and, on careful in¬ quiry, it turned out that the man was intoxicated, and was showing some passers by the methods of horse-taming, and while attempting to fasten the fore leg it was observed that he w'as throwm down, and his leg was doubled up under him ; whether the horse bore his weight on the man could not be ascer¬ tained. In Cases 3, 4, and 9, it was the wheel of a heavy cart or van passing over the ham of the leg. Case 5, while standing a little raised upon the toes and leaning forwards, a sack of wheat fell from a height of seventeen feet, and struck the back part of the leg, about the bend of the joint. Case 6, whilst sitting on a square block of stone, was struck by another, which drove the pop¬ liteal space or ham against the block on which he sat. Case 7, the man was drawn into a revolving shaft, which carried him round and dashed him two or three times against the wall. In two out of these four cases (Cases 4 and 8) the popliteal vein w'as ruptured with the artery, and probably also in Case 6 ; in these instances there was a laceration and crushing of the parts intervening betw'een the integuments ^d joint, these latter structures themselves not being involved. b. Those acting from within outwards. In Cases 1 and 2 the rupture was entirely due to the forcible separation of the ligaments of the knee-joint, and displacement of the femur backwards ; the pos¬ terior and crucial ligaments were all lacerated, and the artery torn through, but the vein, nerves, and integuments remained entire. In Case 3 it is questionable whether the partial dislocation of the knee, or the pas¬ sage of the cart-wheel over the joint, was the cause. In Case 7 the accident is said to have occurred by a violent exertion in vaulting over a boat, hut here the state of the knee-joint is not mentioned. In Cases 4 and 5 it is also questionable whether the probable injury to the knee- joint was not the primary cause; for, from the examination of the limb, although seven weeks after the accident, the condyles of the femur w'ere found exposed, and the greater part of the ligaments had sloughed. In this latter class of cases there is a forcible wrenching and separation of the femur from the tibia^ and it appears that the popliteal artery became torn through^ the vein and nerves almost entirely escaping. This we can readily understand^ for the artery is next and closest to the femur and joint, and would be the first vessel or structure implicated. 2. The symptoms and effects produced by this lesion. —We shall treat these separately, in the order of their occur¬ rence.