Hereditary scoliosis

HG Garland - British medical journal, 1934 - ncbi.nlm.nih.gov
HG Garland
British medical journal, 1934ncbi.nlm.nih.gov
Immobilization of Fractures Mr. R. WATSON JONES read a paper on" Inadequate
Immobilization and Non-Union of Fractures." He said that recent enthusiasm for'early
mobilization and functional activity in fracture treatment was entirely justified, in that
incapacity periods were reduced and many permanent disabilities avoided; but it should be
recognized that joint mobilization must not interfere with absolutely complete and
uninterrupted immobilization of the fracture. There was no more constant cause of nonunion …
Immobilization of Fractures Mr. R. WATSON JONES read a paper on" Inadequate Immobilization and Non-Union of Fractures." He said that recent enthusiasm for'early mobilization and functional activity in fracture treatment was entirely justified, in that incapacity periods were reduced and many permanent disabilities avoided; but it should be recognized that joint mobilization must not interfere with absolutely complete and uninterrupted immobilization of the fracture. There was no more constant cause of nonunion than inadequate immobilization. Hyperaemia of bone caused decalcification. If the initial hyperaemia of the trauma of injury was perpetuated by the frequently repeated trauma of movement of the fragments on each other, decalcification continued until a crack became a cavity, and a linear fracture became a gap fracture. Even slight movement, and especially rotatory movement, was sufficient to account for excessive'decalcification. The Whitman plaster for fracture of the neck of the femur did not as a rule prevent rotatory movement of the pelvis and head of the femur, and for this reason, even in the 50 per cent. of cases which did unite when so treated, there was usually evidence of excessive decalcification in the shortening of the neck of the femur. On the other hand, a Smith-Petersen nail completely prevented rotatory movement, and in the speaker's series of twenty-eight subcapital fractures treated by operation over 90 per cent. had united. In fraLtures of the lower shaft of the ulna, non-union was due to attempted restoration of radio-ulnar movement after six or eight weeks of immobilization, before the fracture was consolidated. The radio-ulnar joint had become stiff, so that the movement could occur just as easily at the unconsolidated fracture as at the stiffened joint. For this reason, in three years the speaker had seen eighteen ununited fractures of the lower shaft of the ulna, although in every case the associated fracture of the radius-which was not subject to rotatory strain-had united. Ifthese fractures were completely immobilized for the three or four months which were necessary to show radiographic evidence of consolidation, non-union never occurred. Fractures of the scaphoid bone in the wrist illustrated the same principle. Recent fractures usually united in six to eight weeks, but sometimes it was necessary to continue immobilization for many months, and if the institution of treatmentwas delayed, twelve to eighteen months of absolute immobility might prove necessary. If the surgeon was prepared to wait for-it, bony union could be secured in practically every case. The speaker's conclusion was that whatever other factors might affect the union of fractures, non-union was only seen if immobilization was incomplete, or if it wasnot continued for a sufficient period.
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