The length of time, during h these spiculae keep up the suppuration and retain tin- wound- open, not only render liipatients the more. but what is of some consequence in military practice, detain the men longer thus encumbering the wards, ami keeping the p00ed to an attack of those fatal forms of pn-v.iil in such circumstances.! to thus f,>rinu!' COmniii! OF TI;I: CKIMF.AN v, more erroneous and more dangerous in surgery, than that which lolls us to respect and retain the fragments of bone partly detached in fractures.
These fragin> almost never recover their vitality, nor become united to the body of the bone;" and he also tells us in another place, to remove not only "those pieces which are entirely detached, but also all those which are movable, vacillating, and capable of being extracted without the necessity of too great destruction." M. Hutin, again, whose position in the Hotel des Invalides gives him larger opportunities of observing the effects of sequestra which have been left unextracted than perhaps any surgeon alive, says, referring to his recorded cases "I have given several observations, taken from among several hundreds, in order to show that the portions of non-extracted bone end sooner or later by setting up eliminativc action, which is always painful, often dangerous, and at times fatal.
I have also reported other cases in which immediate extraction has been followed by positive cures, comparatively prompt. These instances confirm the principles stated above. Like them, or even more, they confirm this truth, that the secondary sequestra, if they are not hurtful at the time when the wound is received, or shortly afterwards, become so almost to a certainty at last. They demonstrate the necessity of removing them." Koux, Baudens, Dupuytren, Outline, and nearly all the leading surgeons who have seen many I had many times the opportunity of seeing that these partially detached fragments seldom lie in the axis of the limb; so that if they did come to enter into the new bone, they would be more a hinderance than an assistance to its ITKI; or I, not only from their position, but the principal sections of tl; ventiiu: their contact and really-necrosed condition makes tin-in ome separated by a iutur" acci and powerfully still as for bodi Finally, considering the question in all its hearr it nr. ir pretty evident that the removal of t e remove' i as possible, but that the same line of practice;ld be followed with regard to those which are so to retain but slight connections, and M continued vitality must be doubtful; that this diould be accomplished by cnlaririnu' tin- exit wound; that the practice is especially necessary in those cases where tie- femur is implicai conical c Th 'ly adherent. should of course never In- interfcn-d illegible in the scan of the first
The resections, however, did remarkably well in the leg and upper extremity. In the classification of injuries which was followed in the Crimea, no distinction unfortunately was made between fractures in the upper, middle, and lower part of the femur, which prevents the discussion of several interesting points. Although making every endeavour, I have only been able to find a record of three cases in which recovery followed a compound fracture in the upper third of the femur without amputation. In two of them the injury was occasioned by round balls, and the comminution was slight. In the third case I could not ascertain what species of ball had caused the injury. In one of these the patient, an officer of the 17th regiment, was in the highest health at the time when he was wounded (8th September), and was of a peculiarly buoyant and hopeful temperament.
The ball entered behind, and was re-moved in front, a little below the great trochanter, by Dr. Ward of his regiment. This patient received an amount of attention which it would have been quite impossible to bestow in the field under ordinary circumstances. He had a mattrass constructed so that his r. OF Tin: r.xTKKMrnr.s. wound could be dressed, and tlic bedpan introduced without disturbing his limb. Hi- was wounded at a time when the comforts of camp-life were little behind those of home; and yet I have been informed, that although his limb was in a very good condition when he left for Kngland, the trouble it lias since given him, and ietbrmed condition in which it remains, make it by no means an agreeable appendage.