The practice of surgery . rti-cularly in hospital practice. We would submit, therefore, that in these cases, surgeons may carrytheir fears of trephining too far for the welfare of their patients.—Ed.] Punctured Fracture. By the term ordinary fracture, with or without displacement, ismeant injury done by an obtuse body, causing solution of continuitythroughout the whole thickness of thebone, and producing fragments com- Fig. 8. posed of both tables of the skull, sepa-rated from their general connection innearly equal proportions. A smooth,uniform, non-penetrating surface is con-sequently presen
The practice of surgery . rti-cularly in hospital practice. We would submit, therefore, that in these cases, surgeons may carrytheir fears of trephining too far for the welfare of their patients.—Ed.] Punctured Fracture. By the term ordinary fracture, with or without displacement, ismeant injury done by an obtuse body, causing solution of continuitythroughout the whole thickness of thebone, and producing fragments com- Fig. 8. posed of both tables of the skull, sepa-rated from their general connection innearly equal proportions. A smooth,uniform, non-penetrating surface is con-sequently presented by the depressedportion to the brain and its when a sharp-pointed substance,as the point of a poker or pitchfork,the corner of a spade, shovel, or ham-mer, or the ancrle of a sharp stone, im- -F ,, . Punctured fracture, lit, ii; nt h, the dura pmges on and penetrates the cranium, m&UtT repre8ented ,„ltn,,hwl> and 8piculw of the nature Of the injury is Very dif- bone lodged in the vacant 64 PUNCTURED FRACTURE. ferent. The external table is crushed by the penetrating body, to anextent proportionate to its lodgement. But the inner table, being muchmore brittle, gives way to a greater extent. It is broken up into frag-ments, usually small and spiculated, which, being driven inwards by theforce of the blow, penetrate, or at least seriously irritate the coveringsof the brain, producing inflammatory action. This may be general, in-volving the brain itself, and to the last degree dangerous; or it may belimited to the injured dura mater, causing abscess there, a result stillmost perilous to life. And to accomplish the latter evil it is not neces-sary that the fragments of the inner table should penetrate, or in anyway mechanically injure the dura mater. It is sufficient that they aredetached from the general cranium, and remain unremoved; they neces-sarily die, and, as sequestra, they inevitably become surrounded bypurulent formation. The rule of practic
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