Fractures and separated epiphyses / by Albert J. Walton.

  • Walton, A. J. (Albert James), 1881-
Date:
1910
Catalogue details

Licence: In copyright

Credit: Fractures and separated epiphyses / by Albert J. Walton. Source: Wellcome Collection.

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    a back splint, with a footpiece, which should reach only to the knee. A pad is placed beneath the heel, so that back- ward displacement is prevented, and not above, as in a fracture of the shaft. Care must be taken to see that the heel is in apposition with the footpiece, and the foot thus at a right angle. Two lateral splints are now applied, a pad, if necessary, being placed between the outer one and the outer side of the foot, so as to overcome eversion. The limb must be slung in a Bloxam’s cradle, so as to flex the knee as much as possible. Massage should be commenced on the second day. Dupuytren s splint should not be used, as the backward displacement and plantar flexion are not overcome, while Syme’s splint, although overcoming the backward deformity, has no effect on the eversion or plantar flexion. Even when inversion is present, the best results will be obtained by the use of a Sharpe’s splint after the deformity is reduced, for, provided that no external pad be used, there will be no tendency to cause inversion, and the other deformities, which are the more important, will be guarded against. It must be remembered that slight inversion causes but slight dis- ability, whereas even a small amount of eversion leads to traumatic flat-foot and much resulting pain and weakness. , In Dupuytren’s fracture the deformity must be fully overcome under an anaesthetic, but even here it tends to recur, the upward displacement of the astragalus being the most difficult to combat. - It is best treated by putting up the foot in a position as fully inverted as possible, so that the inner side of the astragalus rests against the lower end of the tibia, the leg being at the same time as fully flexed at the knee as possible. This may be accomplished by applying a Sharpe’s splint, with a large pad beneath the foot so as to fully invert it. Owing to the tendency of this deformity to recur, passive movements should not be begun until the end of two and a half to three weeks, although massage may be commenced the day after reduction. For this reason, some limitation of movement of the ankle is very likely to result. If the foot cannot be replaced by the above methods, an open operation should be performed. In the majorit}^ of cases an incision over the lower end of the fibula will be sufficient, the ends of the bones being then manipulated