Notes on the modern treatment of fractures . ble. teach me that extensive shattering of the inner table, withonly a moderate amount of fracturing of the external table,is of frequent occurrence in other as well as in punctured frac-tures. I admit that the condition in the cadaver, preservedby zinc chloride, with its shrunken brain, is different fromthat in the living; but there is much evidence of the samesplintering to be found in the study of accidental and homo-cidal cranial fractures. This is in accordance with the well- 70 THE MODERN TREATMENT OF FRACTURES. known mechanical law, that comp
Notes on the modern treatment of fractures . ble. teach me that extensive shattering of the inner table, withonly a moderate amount of fracturing of the external table,is of frequent occurrence in other as well as in punctured frac-tures. I admit that the condition in the cadaver, preservedby zinc chloride, with its shrunken brain, is different fromthat in the living; but there is much evidence of the samesplintering to be found in the study of accidental and homo-cidal cranial fractures. This is in accordance with the well- 70 THE MODERN TREATMENT OF FRACTURES. known mechanical law, that compressing force applied to theoutside of a surface, as are undoubtedly most fracturing forcesapplied to the skull, tends to produce more extensive breakingof the inner surface. This is especially so in all localizedblows. Punctured fractures have long been treated by earlytrephining, to avert encephalitis. For the same reason Irecommend resort to trephining even in more diffused and lessaccentuated fractures. It is to prevent inflammatory se-. Fig. 8. Accentuated fracture showing marked depression of internaltable revealed by trephining. Same case as Fig. 7. quences due to splinters forced into the membranes and brainand to avert a consecutive occurrence of epilepsy and insanity,that the operation should be performed; not because of thefear that symptoms of compression of the brain may arise,nor because necrosis of detached portions of bone may there is no fissure in the outer table, though theinner table is extensively broken and depressed. Twentysuch cases are reported as having occurred during the late CivilWar.* All of these patients died from intracranial inflam- * Medical and Surgical History Rebellion, Pt. I., Surgical Volume, FRACTURES OF THE CRANIUM. 71 niation except one, in which the splintered portion of theinner table was removed as a sequestrum.* I show you apiece of skull removed from a patient who recently died undermy care. He was struck wi
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Keywords: ., bookcentury1800, bookdecade1890, bookidnote, booksubjectfractures
