Daily Kennebec journal., 1910-12-27

cisioa whether or not to perform an
oren oreration will depend upon the
surgeons experience ana views.
"W. A. Lane of London is the most
prominent advocate of open opera
ticns in practically every case OF
fracture where the skiagram shows
displacement of fragments which cen
not be reduced indirectly. Stimsoh
stands at the other extreme and de-
cries any attempt at open operation
except in rare instances. Meanwhile
the number of cases of fracture cons
sidered as amenable to open operation
constantly Increases.
Il will not discuss the pros and cons
of this question, but will describe the
method, which appeals to me after ex-
pcrimenting with several, as the best
operation for general use, namely, that
which makes use of steel screws ana
aluminium plates. Steel screws are
used because they have given salts
faction and are easily procured.
"The principal objection to the COM
mon wood screws in bone work is that
its thread is not continued throughout
Its length. Screws answering these re-
ouirements. however, may be obtained
in London. On the other hand. If
screw be selected whose point extends
into the cortex on the opposite side OF
the bone it will not fail to hold the
splint securely.
aluminium is the metal of choice for
cleats because, while strong enough.
it is easily worked into shane at the
of
ment A piece of sheet metal of the
proper thickness is selected and cut
to an aprropriateN shape with scissors.
Three or four holes are bored in 1t
with any sharp steel point and trim
med smooth with a pocket knife and
it is sterilized with the instruments.
Lane has multiplied the number OF
instruments for use in such cases and
has devised steel plates of many
shapes and sizes. but if aluminium be
used it is easy to prepare it after the
site Of fracture is exposed and the
the case becomes evident.
Among the disadvantages of open
operation for fracture are those due
to the technique necessary with sut-
ure or intermeduliary splints. Some
of these drawbacks. are obviated by
the use of the aluminium plate. The
great amount of trauma necessary i'll
exposing all sides of the fragments
for some distance from the fracture,
so as to drill through the bone or ap-
ply n splint to its cavity, is quite done
away with When a plate or cleat Is
used to hold the fragments in place.
In the latter case it is not necessary
t. expose much or strip any OF the
pcriosteum.
"It suffices merely to expose enough
OF the fragments so that the plate may
rest against them, without injurlng
the periosteum more than to puncturc
it for the screwholes. The ends of the
fragments are held in place with
stout hook or elevator slipped under
that one which needs to be pulled into
place while the plate is being applied.
srhc peristeum may be included be-
tween plate and bone without harm.
The size Of the drill bears definite
relation to the size of the screw which
it to follow \ convenient plan is to
use a mechanics wire gauge to meas
ure the caliber CT the screw which mas
been selected for use. Then q drill is
selected two sizes smaller.
This screw, when driven into the
bone will fit snugly and resist great
force in attempting to dislodge 1t.
With the plate lying in position. bridg-
ing the site of fracture, the drill is
put through one of the holes in it and
driven into the bone. 4 screw follows.
With the plate now fastened in place
as a guide the other holes are drilled
in their proper places.
'The number of screws to be ap-
piled will depend upon the tendency
Of the fragments to become displaced,
but there should be in all cases more
than the screw on one side Of the
fracture. Otherwise. hinge. motion
will be allowed cr the screws entirely
Gislodgel.
st has beer objected that the
screws, acting as foreign bodies anu
| irritants, will cause absorption of the
bone around them and thus become
so loose as to be useless. This OBJ
| lection would seem to apply theoret-
icallv more certainly if machine
screws, with their shallow threads.
were used than will wood screws.
"Those plates which l have used
| have held firmly at least until relieved
| of their work by natural union of the
fragments. On removing both screws
| and plates I have found them to be
| firmly enough inlhedded to necessitate
| being pried out of their resting places:
but those which I have removed have
all remained in place for many