Surgery of Modern Warfare IV. (töredék) [antikvár]

SECTION XIWOUNDS OF BONES AND JOINTSCHAPTER L WOUNDS OF BONEWOUNDS of bone cannot occur alone. We are concerned here, not with the treatment of war wounds in general, but with those of a particular tissue of comparatively low vitality and absorptive power.The problem before us is largely the problem of the compound fracture, upon which surgical attention has been focused, both in times of peace and war. In May 1866 Lister treated successfully a compound fracture of the leg by swabbing the wound with crude creosote and covering it with plaster of Paris impregnated with the same chemical. The day of conservative surgery in compound fractures had dawned.Remarkable progress has been made in this field, and it is probable that finality has not yet been reached. Perhaps even more than with other problems connected with war surgery, it must be realized that sound judgmentwhen to operate, when to amputate, when to excise the wound meticulously and when to perform rapid but purposeful debridementis far more important than blowing sulphanilamide powder around the broken bone and encasing the limb in plaster, excellent as these procedures may be in their proper sphere.The time factor is the very crux of the situation. The earlier a compound fracture can receive attention in the operating theatre, the better the prognosis. Every half-hour counts. In compound fractures of peace, a limit of eight hours was generally conceded the maximum in which it was permissible, after adequate cleansing, to suture the wound ; in other words, to convert an open fractrae into a closed one. It is doubtful if it is ever advisable to carry out this ideal in its entirety in war wounds, except in selected cases of bullet wounds.Resuscitation is as important here as with other wounds. To determine the mean between the urge to transfer the patient to the theatre in order to treat his local condition, and the anxiety to retain him in the resuscitation ward 59507Pig. 624A perforating wound of the lower end of the femur, if situated within a hand's-breadth of the superior surface of the patella, may involve the knee-jomt.