To work out this point in figures so extensive as to be of any use, would require details not supplied by writers on the old war3. ITKK OF Tin: KXTKKMITIES. channels, or perforates its substance, without splitting it, like a wedge; nor does it ever come to mark a hone with any t<nch more Liyntle than what occasions its utter detin. In the (Y h id many opportunities of observing tin- action of h-th kinds of hall, and so far as I uld judire, their eti'.-ets were so dissimilar, as almost to justit. tiration if injuries founded mi the kind of hall -riving rise to The longitudinal splitting of the bone is so dexterously and extensively accomplitieae halls that, while but a small opening may lead to the seat of fracture, the whole shaft may be rent tr -m end to end.
I have repeatedly seen the greater part of the femur so split. Stromeyer has shown that this Longitudinal splitting seldom transgressed the line of 18, an observation which I can most decidedly confirm; for though the injury has at times heen suffiimplicate h.th, yet the rule has been just as he s. Gun-shot fractures.f tinextremities.f hune have always hrm cnnsid.Trd dangerous, chiefly on account of nnninution of bone, and the fact, that A trading to it is of such a character that i; heal only by suppuration, and cannot be so cloconvert it fracture, which, it is well-known. 'an sometimes accomplish in such fractures as thri: to nin civil pi The cavity of the. pt to the air; the pus undergoes i then remarks I refer mercl hall, OB there are of the same ahape but of lew v '. no means o fonni.lable.
That used in the Schleswic-Holstetn campaigns appears to have been very trivial in comparison to the large Russian one, of which wo hod such dire experience. WAli. those changes which Bonnet has shown it does under such circumstances, and that severe and prolonged inflammation of the deep and irritable tissues which constitutes the chief danger in compound fractures, cannot be Now, all of these dangerous characteristics of compound fractures have been immensely increased by the conical ball. First of all, the shock it occasions is undoubtedly greater than that caused by the round ball, simply because the destruction it causes is much more severe; secondly, the comminution of bone is enormously increased. The number of fragments which are quite detached are much more numerous, and the amount of sequestra, which are so far severed as to be ultimately thrown out before a cure can be looked for, is much greater.
Thirdly, the bruising of the soft parts is more extensive, so that the suppuration is more prolonged, and the changes of purulent absorption so much the more multiplied. The great loss of substance which follows compound fractures by the conical ball, is the source of one peculiarity in their treatment. The shortening will be "All the complete fractures of the other bones of the extremities unite when they are well managed; by what fatality are those of the femur not equally fortunate? Is it the diameter of the cavity of the bone; the quantity of medullary substance which it contains; the peculiar structure of the which carry the nourishment; the size and force of the muscles which arc attached to it, which, by their weight and pressure, obstruct the passage <>f the liquids?
All these causes united may combine together, and give rise to that want of success which we meet with in treating complete fractures of the femur caused by fire-arms; but complete fractures of this bone heal very well, whatever cause has produced them, when they are not accompani; D a method for amputating the thigh at (lie hip, d f/tnf io try and snatch the from rinr',ii,i,i death."Koranton, p. i ITIM: OF Tin: lould consolidation follow, than it' tin- injury had ned by the round ball. The conviction i strongly impressed upon my mind, by tinobservation.-I' not a few of i: I, that we oii-'lil not to keep up extrusion in tht'ir treatment, except in a lilied degree.
If we do so if we drag and haul at the lione, as I have often sy the muscles towards one another. >'d the sequent HI and attend merely to ihe limb as straight as possible; or, in other words, do not be troubled with the displacement as to only as to the thiekurs< ot' the bone, and have and a limb of which I, for one, by no m the k '"' ihe test of good man mi-lit, then think oiu- hop,n in some step like 'I'll mces of compound fracture which in which the i- but little. led. and which demand a ferent consideration altogether from those I have been speaking of.
These accidents commonly arise from the contusion of a round shot, or the contact of a piece of shell. They are, however, so very rare and difficult to recognize, that less harm will follow from the same line of practice being pursued with them, viz., that of immediate if by being careful about such rare exceptions, we run the extreme hazard of sacrificing the majority of cases which determine the rule. The extensive comminution of the bone by a conical ball, makes the indications with regard to the management of the sequestra more evident than it is commonly considered. I do not think we paid sufficient attention to their removal in the East. It may be true, as some tell us, that in fractures with the old ball, it was desirable to meddle as little as possible with the fragments; but this is the teaching of only a few.