Obrázky stránek
PDF
ePub
[blocks in formation]
[blocks in formation]

J. C. ABERNATHY, M.D.......

M. A. AUERBACH M.D., PH.G........

M. BESHOAR, M.D........

T. J. BIGGS, M.D

PROF. D. B. BLAKE, M.D.

JOHN L. BRANCH, M.D.....

HON. JOHN M. BRIGHT....

PROF. PERRY BROMBERG, M.D...........

R. C. BURROW, M.D..........
JAMES M. CLOPTON, M.D...

PROF. A. B. COOKE, M.D..

WILLIS E. CUMMINGS, M.D..........
JOHN L. DISMUKES, M.D......

H. S. DRAKE, M.D........

Atlanta New York.

..Colorado. .Connecticnt.

...Tennessee. ..Georgia. Tennessee.

.Tennessee.

..Kentucky.
Alabama.
..Tennessee.

.New York.
.Kentucky
Kentucky.

Tennessee.

M.D.

.Tennessee.

G. P. EDWARDS, M.D.....
PROF. DUNCAN EVE, A.M.,
FRANK FULTON, M.D., C.M..
R. E. FORT, M.D......
PROF. JAMES W. HANDLY, M.D.
JAMES T. HERRON, M.D.................
EDWARD C. HILL, M.D........
WILLIAM KRAUSS, M.D.......
PROF. LOUIS LEROY, M.D.......
SAMUEL E. LEWIS, M.D
R. B. MACON, M.D....
M. C. MCGANNON, M.D...

J. A. MCSWAIN, M.D..

E. J. MELVILLE, M.D.......

H. PLYMPTON, M.D..

E. W. RIDINGS, M.D........

E. C. ROEMLE, M.D., PH.G........
DEERING J. ROBERTS, M.D....
CHARLES F. SAUTER, M.D
PROF. D. D. SAUNDERS, M.D.......
CHARLES H. SHEPARD, M.D...
C. W. SIMPSON, M.D......
W. HARPER SMITH, M.D........

8. H. STOUT, A.M., M.D., LL.D..

C. H. TEBAULT, M.D.....
JOHN J. TERRELL, M.D..........

GEORGE C. TRAWICK, M.D...............................
JOHN TRAWICK, M.D....
W. C. WELBURN, M.D...

E. E. WILLEY, M.D........

[blocks in formation]
[graphic][merged small][subsumed]

THE SOUTHERN PRACTITIONER,

AN INDEPENDENT MONTHLY JOURNAL,

DEVOTED TO MEDICINE AND SURGERY.

SUBSCRIPTION PRICE, ONE DOLLAR PER YEAR.

[blocks in formation]

Professor of Surgery and Clinical Surgery in Vanderbilt University,
Medical Department.

Mr. President and Gentlemen of the Academy:

Complications of fractures and their management is a big theme, and can only tolerably be dealt with in the time allowed. We will, therefore, only in a very practical way treat the subject.

Injuries to the soft parts as immediate complications often demand special treatment. Lacerated muscles requires suturing,

*Read at Nashville Academy of Medicine, Dec. 10, 1901.

or if macerated should be removed. Injuries of the viscera are are to be dealt with according to the character of the damage sustained. Large blood vessels are frequently lacerated either by the force which causes the fracture or by the end of the bone. Such lacerations may give rise to an extensive effusion of blood into the tissues in the shape of swelling or local hematoma. If the swelling is considerable the bleeding point should be exposed and ligated.

Traumatic aneurysms are sometimes associated with fractures. Displaced bone against a vessel may impede the circulation to such a degree as to cause gangrene. Injury to nerves at the time of fracture is no uncommon complication. It may be in the form of laceration, compression or stretching of the nerve. All these are manifestated with pain and more or less disturbance of the parts beyond; sometimes in the way of paralysis, and the surgeon is compelled in some cases to expose the nerve and suture the ends, if laceration is discovered.

In the latter complications, pressure from effused serum takes place to such a degree that sloughing or gangrene is threatened. This may be relieved by multiple longitudinal incisions for the escape of the serum, followed by elevation of the limb.

Edema is usually relieved on removal of bandage and dressings, and does not call for any special treatment. The more perfect a fracture is reduced and the more perfectly it is immobilized the less will be the swelling.

Ulceration, sloughing and gangrene, due to tight bandages or pressure of splints, are dangers always to be guarded against. The tips of the fingers and toes should be left exposed in order to observe the circulation. The shock a fractured limb receives, causes diminished vitality. The dressings should be removed frequently. Patients with diabetes, atheromatous vessels and cardiac disease are liable to gangrene following fractures. Thrombosis occurring in large vascular trunks, as sometimes follows fracture, is a prolific cause of gangrene, the treatment of which must depend upon the absence or presence of infection.

Fat-embolism is a condition peculiar to fractures, and comes on about the fourth day, and is due to the liberation of fat from the medula, its entrance into the open vein and its transmission through the circulation to the various parts of the body. Pa

« PředchozíPokračovat »