A manual of operative surgery . act,in all cases of simpledepressed fracture,excepting only thosewhich are describedas pond or , and providedonly that these oc-cur in young chil-dren and are givingno signs of pressure, for in such cases the bone is soft and mem-branous, and the lesion consists of an inward bulging ratherthan a fracture, there being no inwardly projecting sharp points<of bone ; and in many of these it will be found that the lesionis reduced spontaneously in the course of a few days. Shouldsigns of pressure or irritation develop, the depressed area mustbe elevate
A manual of operative surgery . act,in all cases of simpledepressed fracture,excepting only thosewhich are describedas pond or , and providedonly that these oc-cur in young chil-dren and are givingno signs of pressure, for in such cases the bone is soft and mem-branous, and the lesion consists of an inward bulging ratherthan a fracture, there being no inwardly projecting sharp points<of bone ; and in many of these it will be found that the lesionis reduced spontaneously in the course of a few days. Shouldsigns of pressure or irritation develop, the depressed area mustbe elevated by surgical procedures. Such a case as is depictedin Fig. 201 would require operation. Here the edges of thedepression are sharply broken off, and symptoms either immediateor remote would be certain to follow if the condition were leftuntreated. (3) Punctured Fractures.—-These include punctured fractures•of the vault, produced usually by some sharp instrument, andpunctured fractures of the base. Those of the vault must in. FIG. 202.—INNER SURFACE OF SPECIMEN SHOWN INFIG. 201. 16 OPERATIONS ON HEAD AND NECK [part m all cases be operated on, however small the wound in the softtissues and outer table of the bone may appear, and howeverfree from symptoms the patient may be. No other course ispermissible. The amount of damage to the inner table is nearlyalways in excess of that to the outer table. There may havebeen injury to the underlying brain, and portions of the instru-ment causing the damage or of septic material coating it mayhave been left behind. Fractures of the base, such as punctures ofthe anterior fossa through the orbit or nose, or of the middlefossa through the temporal region, are usually associated withdepressed portions of bone, and in nearly all cases are followedby septic symptoms, either of which may require operativetreatment. In many such the symptoms are at first trivial,and the wound of entry is situated at some considerable distancefrom the site of
Size: 1931px × 1293px
Photo credit: © The Reading Room / Alamy / Afripics
License: Licensed
Model Released: No
Keywords: ., bookcentury1900, booksub, booksubjectsurgicalproceduresoperative
