第 4 节
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没事找事 更新:2021-10-16 18:43 字数:9322
very sharp。 But in oblique fractures the case is similar to that of
bones which have been torn away; as formerly described; for they do
not admit of being restored to their place; and the prominence of
the bone is very sharp。 For the most part; then; it should be known;
no harm results to the shoulder or to the rest of the body from
fracture of the clavicle; unless it sphacelate; and this rarely
happens。 A deformity; however; may arise from fracture of the
clavicle; and in these cases it is very great at first; but by and
by it becomes less。 A fractured clavicle; like all other spongy bones;
gets speedily united; for all such bones form callus in a short
time。 When; then; a fracture has recently taken place; the patients
attach much importance to it; as supposing the mischief greater than
it really is; and the physicians bestow great pains in order that it
may be properly bandaged; but in a little time the patients; having no
pain; nor finding any impediment to their walking or eating; become
negligent; and the physicians finding they cannot make the parts
look well; take themselves off; and are not sorry at the neglect of
the patients; and in the meantime the callus is quickly formed。 The
method of dressing which is most appropriate; is similar to that
used in ordinary cases; consisting of cerate; compresses; and
bandages; and it should be most especially known in this operation;
that most compresses should be placed on the projecting bone; and that
the greatest pressure should be made there。 There are certain
physicians who make a show of superior skill by binding a heavy
piece of lead on the part in order to depress the projecting bone; but
this mode of treatment does not apply to the clavicle; for it is
impossible to depress the projecting part to any extent worth
mentioning。 There are others who; knowing the fact that the bandages
are apt to slip off; and that they do not keep the projecting parts in
their place; apply compresses and bandages like the others; and then
having girt the patient with a girdle; where it is usually applied
with most effect; they make a heap of the compresses upon of the
compresses upon the projecting bone when they apply them; and having
fastened the head of the bandage to the girdle in front; they apply it
so as to bring the turns of it into the line of the clavicle; carrying
them to the back; and then bringing them around the girdle they
carry them to the fore part and again backward。 There are others who
do not apply the bandage round the girdle; but carry the rounds of
it by the perineum and anus; and along the spine; so as to compress
the fracture。 To an inexperienced person these methods will appear not
far from natural; but when tied; they will be found of no service; for
they do not remain firm any length of time; even if the patient keep
his bed; although in this position they answer best; and yet even when
lying in bed; should he bend his leg; or should his trunk be bent; all
the will be displaced; and; moreover; the bandaging is inconvenient;
in as much as the anus is comprehended by it; and many turns of the
bandage are crowded there in a narrow space。 And in the method with
the girdle; the girdle cannot be so firmly girt around; but that the
turns of the bandage force the girdle to ascend; and hence of
necessity all the other bandages must be slackened。 He would seem to
me to come nearest his purpose; although after all he effects but
little; who would take a few turns round the girdle; few turns round
the girdle; but would use the bandage principally to secure the former
bandaging; for in this manner the bandages would be most secure; and
would mutually assist one another。 Every thing now almost has been
said which applies to fracture of the clavicle。 But this also should
be known; that in fractures of the clavicle; it is the part attached
to the breast which is uppermost; and that the piece attached to the
acromion is the lowermost。 The cause of this is; that for the most
part the breast can neither be depressed nor raised; there being but a
slight movement of the joint at the breast; for the sternum is
connected together on both sides with the spine。 The clavicle admits
of most motion at the joint of the shoulder; and this arises from
its connection with the acromion。 And; moreover; when broken; the part
which is connected with the sternum flies upward; and is not easily
forced downward; for it is naturally light; and there is more room for
it above than below。 But the shoulder; the arm; and the parts
connected with them; are easily moved from the sides and breast;
and; on that account; they admit of being considerably elevated and
depressed。 When; therefore; the clavicle is broken; the fragment
attached to the shoulder inclines downward; for it inclines much
more readily with the shoulder and arm downward than upward。 Matters
being as I have stated; they act imprudently who think to depress
the projecting end of the bone。 But it is clear that the under part
ought to be brought to the upper; for the former is the movable
part; and that which has been displaced from its natural position。
It is obvious; therefore; that there is no other way of applying force
to it (for the bandages no more force it to than they force it
from); but if one will push the arm when at the sides as much as
possible upward; so that the shoulder may appear as sharp as possible;
it is clear that in this way it will be adjusted to the fragment of
the bone connected with the breast from which it was torn。 If one then
will apply a bandage; secundum artem; for the purpose of promoting a
speedy cure; and will reckon everything else of no value; except the
position as described; he will form a correct opinion of the case; and
will effect a cure in the speediest and most appropriate manner。 It is
of great importance; however; that the patient should lie in a
recumbent posture。 Fourteen days will be sufficient if he keep
quiet; and twenty at most。
15。 But if the clavicle be fractured in the opposite manner (which
does not readily happen); so that the fragment of bone connected
with the breast is depressed; while the piece connected with the
acromion is raised up and rides over other; this case does not require
much management; for if the shoulder and arm be let go; the
fragments of the bone will be adjusted to one another; and an ordinary
bandage will suffice; and the callus will be formed in the course of a
few days。
16。 If the fracture be not thus; but if it incline either forward or
backward; it may be restored to its natural position; by raising the
shoulder with the arm as formerly described; and brought back to its
natural place; when the cure will be speedily accomplished。 Most of
the varieties of displacement may be rectified by raising the arm
upward。 When the upper bone is displaced laterally or downward; it
would favor the adaptation of the parts if the patient would lie on
his back; and if some elevated substance were placed between the
shoulder…blades; so that the breast may be depressed as much as
possible upon the two sides; and if; while another person raised the
arm extended along the sides; the physician; applying the palm of
the one hand to the head of the bone; would push it away; and with the
other would adjust the broken bones; he would thus reduce the parts
most readily to their natural position。 But; as formerly stated; the
upper bone (sternal fragment?) is rarely depressed downward。 In most
cases; after the bandages have been applied; that position is
beneficial in which the elbow is fixed to the same side; and the
shoulder is kept elevated; but in certain cases; the shoulder is to be
raised; as has been directed; and the elbow is to be brought forward
to the breast; and the hand laid on the acromion of the sound side。 If
the patient has the resolution to lie in bed; something should be
placed so as to support the shoulder; and keep it as much elevated
as possible。 But if he walk about; the arm should be slung in a shawl;
which embraces the point of the elbow; and is passed round the neck。
17。 When the elbow…joint is displaced or dislocated to the side or
outward; while its sharp point (olecranon?) remains in the cavity of
the humerus; extension is to be made in a straight line; and the
projecting part is to be pushed backward and to the side。
18。 In complete dislocations toward either side; extension is to
be made as in bandaging fracture of the arm; for thus the rounded part
of the elbow will not form an obstacle to it。 Dislocation; for the
most part; takes place toward the sides (inwardly?)。 Reduction is to
be effected by separating (the bones) as much as possible; so that the
end (of the humerus) may not come in contact with the olecranon; and
it is to be carried up; and turned round; and not forced in a straight
line; and; at the same time; the opposite sides are to be pushed
together; and propelled into their proper place。 It will further
assist if rotation of the fore…arm be made at the elbow; sometimes
turning it into a supine position; and sometimes into a prone。 The
position for the treatment consists in keeping the hand a little
higher than