In one of these fatal cases, in the 44th regiment, both knee-joints were involved, and death took place from shock in 12 hours; in another, in the 68th regiment, it occurred on the tenth day, the result apparently of inflammation and suppuration of the joint; and in the third from the same cause, at a little later period. There can, however, be no question but that a large proportion of the 33 cases and 11 deaths, in which the specific joint involved has not been reported, were of this description. The cause of death in the three officers is not specially reported." " The results, then, as above given, do not appear very encouraging toward an attempt to save the limb when any of the larger joints (the knee more especially), is involved, as we have seen that the recoveries in the last me? tioned injuries, without operation, amounted to l-3rd only of the cases reported.
With regard, however, to those of the upper extremity, no great harm appears to have resulted from the attempt at preservation; secondary operations having proved available without any large addition to the risk of life by the proceeding. Of the knee, however, such cannot be said, secondary The amount of injury done to the bone, appears to have been a most important element in determining the treatment of such cases. In none of the recoveries from gun-shot wounds of this joint does the bone within the capsule appear to have been more than grazed (not fractured); indeed, small fissures into the joint often render-d secondary amputation necessary, or proved directly fatal, as in the case of a man of the 71st regiment, accidentally shot in the street of Balaklava- by a small revolver bullet.
The missile had embedded itself in the tibia, just below its tuberosity, whence it was easily turned out by a pointed instrument after a small incision had laid the site open. The knee-joint did not appe;.r from th'> effects of accompai, nation through tinhead of the tibia into the joint. The c-on-litnti ious habits April 1. lowing occurred re war: '.entity. Fle.-h toutu.-i.nl> 59,:;acture of long L. i-ini of n.iinii -i. ami parti;.!. 2, and m,re of the humerus,; tated; coinjwund fracture of forearm, 5, 4 of which ami>i. - or ulna al-nn',
as hapj>cned to an officer of the royal artillery at the great u th. internal of the us was thus taken A.,:id he ned to duty "The success. encouraging in the verse.
of rrseveral b; death having rnii"l. nor KTnputation having l>een resrt<>d to either w n y or secondan- proceeding), is as follows: Uumer l-onw, 35-0; radius only. 70-0; ulna only, 70-0; femur, 8'0; lev: bones, i is 3 inched i < ss of the homcrus was remov tod, with a useful arm. WA!I. " Attempts at preservation of the limb in fractures of the radius and ulna wore even more successful than in the case of the humerus, as the percentage of recoveries will already have made apparent; and it is remarkable that here one only was broken, the ratio was the same for each of these bones, ami ly double that existing when both bones had been fractured.
Excision of portions of the radius and ulna, although not perhaps on the whole so successful, in respect to the perfect use of the limb, retained by the patient, as those of the humerus, were also resorted to, and with good effect, both as primary and secondary operations. " In gun-shot compound fractures of the femur, the deaths returned in the table at page 103 only amount to 82 per cent, of the cases treated without operation, and among these a large proportion of limbs torn off by round shot are included, which, as we have already seen, was almost always a fatal accident, while the percentage of deaths in amputation of the thigh reaches 65-2. From this it would at first sight appear that the success attending attempts at the preservation of the limb with fracture of this bone had been nearly as great as that in those cases where the limb was condemned and removed.
It must, however, be borne in mind, that the recoveries without operation have only amounted to 14 out of 174 cases among the men, and out of 20 among the officers, or 10 per cent., and that all those selected for the experiment of preserving the limb were so chosen, expressly on account of the comparatively small amount of injury done both to the bone and the soft parts, and that even then recovery was always tedious, and the risks during a long course of treatment numerous and grave. In many eases, also, inevitable, and it was thought right the patient should be allowed the benefit of the chance, however small, afforded by operation. By this means the number of deaths among the operations is swelled; while, at the same time, the number of deaths due to the fracture is by so much diminished, ami the percentage, therefore, tells doubly in favour of treatment without operation.