Daily Kennebec journal., 1911-01-05


Academy Of Science on the subject.
sayiag:
No rlattcr how far the operative
treatment of fracture may advance
toward perfection. there viii, doubt =
legs. rCtiain q large majority of case :
best treated ~ ordinary splutn and
massage There win also rcnain L
class uf burGrr line cases whore It de-
cIsion whether or not - perform an
open operation will depend npen the
S:de"oG'S tXpprionc" and views
wv. "A. Lane of I."n6on is the mos.
prominent @dNoCat1 ~ open opera
t! ms, in practically cvcIv cuSr Of trac-
ture whore the s';iagram Yhov $ mis-
placement or frr Slnorts which can not
h" reduced Indirectly. Stimson stands
at the other extreme and dccr:rs .IEF
attempt 1T open operation cXccrt in
rare Instances. Meanwhile the number
Of cases of fracture considered as
amenatle TO open operation constantly
Increases
I will not discuss the pros and cons
OF this question, but will describe the
r1ethod. wi,icf ~ poals to me after ex-
pedimentinG With several, os the best
operation for general use, namely that
which makes use Of steel screws and
alum,nurn platcs. Steel screws are
used because they have given salts
faction and are easily procured.
TIE principal objection to the
eorlmon wood screws in bone work is
init It's thread is not continued
throughout its length. Screws an
sWering these reuuircmeIts, however,
may be obtained in London. On the
other hand. if fCscrew be selected
wil0se point extends into the cortex on
the opposite side of the bone 1t will
not fail to hold the splint securely
aluminium is the metal OF choice
for cleats because. while strong
enough, il is easily worked into shapa
at the time of operation to suit any re
quifemcat. A piece Of sheet metal Of
the proper thickness is selected and
cut to an appropriate shape with scis
surs. Three or four holes are bored in
it with any Snarr steel point and
trimmed smooth with a pocket kuifc
and il is sterilized With the instru-
ments.
Lane has multiplied the number OF
instruments fer use in such cases anG
has devised steel plates of many
shapes and sizes. but if aluminunl lie
used it is easy t. prepare il after TIL.
site Of the fracture is exposed and the
case become evident.
Among the disadvantages of open
operation Tor fracture ara these due
to the technique necessary with suit
ure az intermediary splints. :oue
nf ray al, tod lN
tie usc of the aluminium plate. Th
great ,.rlornt Of trauna necessary in
exposing all sides of the fragment :
for sorle distance from the f:actura
SO as to drill through the bone ar APP
ply Il spiint to its cavity. is quite done
away With when plate or cleat is
used To hn.d the fra ragments in place.
III the latter case it is not necessary
to eNpoS" much NJ strip amy of the
p riosteum.
1t Suticps t.seIely to expose enough
o. L - fragments so that the plate may
rest ag mt them. without inJUring
tne perioSteum more than ta pincture
| it for tie screwhoisS. The ends Of the
fragments ale held in place with Il
stnul hook or rl,vator slipped under
cat one which needs to be pulled into
place " nile tie plate is being applied
The pcristcuIn may be inclued be-
| tween plato and bone without harm.
TIE size of the Grill bears a definite
| relation to the size of the screw which
is to follow. .A "ouve niert plan is IL
USE 4 Iaechanics wire gauge to meas
ure the oIlibcr of the screw Whicn has
been Seit cted for use. Then a drill is
selected TWO sizes smaller.
This screw. when driven into the
bone viii fit sru-ly and resist great
force ins attempting 10 dislodge it.
With the Plate lVlng in position. bridg-
! lag the site of fracture. the drill is
put through one Of the holes in it and
driven iGto the bone. A screw follows.
When the plate now fastened in place
as a guide, the other holes are drilled
in their proper PAGES.
TIE 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 thf
| fracture. otherwise. hinge motion will
| be allowed or the screw entirely dis
| lodged
1t hos been objected that the
screws. acting as foreign bodies ana
| irritaits. win cause ABSORPTION of the
| bone around them and thus become
| so loose as to be useless. This OBJ
| lection would seem to apply theoreti-
| cally more certainly if machine screws
| with their shallow threads, were used
| than will wood screws.
Those plates which | have used
have held firmly at least until relieved
| of tEeir work by natural union of the
| fra gnents On removing both screws
and plate | nave found them to be
| firmly enough imbedded to necessitatt
| being pre6 out of their resting places
but those which ] have removed haV'
all remained in place for many
| months st. Louis Post Dispatch.