The treatment of fractures . knee, a cart-wheel accident to a young boy, attended by considerable shock,followed by great swelling of the knee, a fullness in the pop-liteal space, feeble or absent pulsation in the dorsalis pedis andposterior tibial arteries, increased lateral and anteroposteriormobility at the knee, and soft crepitus form the picture charac-teristic of a separation of the lower femoral epiphysis. 3H FRACTURES OF THE FEMUR Prognosis.—It is impossible to state positively that in any givencase there will or will not be shortening of the leg upon the injuredside because of a cessa
The treatment of fractures . knee, a cart-wheel accident to a young boy, attended by considerable shock,followed by great swelling of the knee, a fullness in the pop-liteal space, feeble or absent pulsation in the dorsalis pedis andposterior tibial arteries, increased lateral and anteroposteriormobility at the knee, and soft crepitus form the picture charac-teristic of a separation of the lower femoral epiphysis. 3H FRACTURES OF THE FEMUR Prognosis.—It is impossible to state positively that in any givencase there will or will not be shortening of the leg upon the injuredside because of a cessation of growth in the femoral epiphysis. Ifthe epiphysis is separated without great laceration and periostealdenudation and is replaced soon after the injury, the chances arethat there will be a minimum amount of shortening of the affectedleg. After open incision and replacing of the epiphysis in closedfractures good results are to be expected as far as the useful-ness of the joint is concerned. Slight necrosis of bone may. Fig. 438.—Method of grasping knee to reduce a displaced femoral epiphysis. Note thumbsat anterior border of epiphysis and fingers upon the lower end of the femoral diaphysis. attend convalescence. If the separation is closed and reductionis impossible by manipulation alone, open incision should bemade. Treatment.—If the vessels arc torn ; if there is great lacerationof the soft parts, amputation should be performed. If the sepa-ration is open and the shaft of the femur protrudes through thewound, and much of the diaphysis is seen to be denuded ofperiosteum, the diaphysis should be resected to the limit of peri-osteal separation, and then the bone reduced. It may be neces- SEPARATION OF HE LOWER EPIPHYSIS 315 sary to enlarge the opening in the soft parts before it is possibleto reduce the bone. If the separation is closed, reduction bymanipulation should be attempted : if successful, the leg shouldbe flexed to a right angle or an acute angle and immobil
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Keywords: ., bookcentury1900, bookdecade1900, booksubjectfractur, bookyear1901
