第 4 节
作者:没事找事      更新:2021-10-16 18:43      字数:9322
  very sharp。 But in oblique fractures the case is similar to that of
  bones which have been torn away; as formerly described; for they do
  not admit of being restored to their place; and the prominence of
  the bone is very sharp。 For the most part; then; it should be known;
  no harm results to the shoulder or to the rest of the body from
  fracture of the clavicle; unless it sphacelate; and this rarely
  happens。 A deformity; however; may arise from fracture of the
  clavicle; and in these cases it is very great at first; but by and
  by it becomes less。 A fractured clavicle; like all other spongy bones;
  gets speedily united; for all such bones form callus in a short
  time。 When; then; a fracture has recently taken place; the patients
  attach much importance to it; as supposing the mischief greater than
  it really is; and the physicians bestow great pains in order that it
  may be properly bandaged; but in a little time the patients; having no
  pain; nor finding any impediment to their walking or eating; become
  negligent; and the physicians finding they cannot make the parts
  look well; take themselves off; and are not sorry at the neglect of
  the patients; and in the meantime the callus is quickly formed。 The
  method of dressing which is most appropriate; is similar to that
  used in ordinary cases; consisting of cerate; compresses; and
  bandages; and it should be most especially known in this operation;
  that most compresses should be placed on the projecting bone; and that
  the greatest pressure should be made there。 There are certain
  physicians who make a show of superior skill by binding a heavy
  piece of lead on the part in order to depress the projecting bone; but
  this mode of treatment does not apply to the clavicle; for it is
  impossible to depress the projecting part to any extent worth
  mentioning。 There are others who; knowing the fact that the bandages
  are apt to slip off; and that they do not keep the projecting parts in
  their place; apply compresses and bandages like the others; and then
  having girt the patient with a girdle; where it is usually applied
  with most effect; they make a heap of the compresses upon of the
  compresses upon the projecting bone when they apply them; and having
  fastened the head of the bandage to the girdle in front; they apply it
  so as to bring the turns of it into the line of the clavicle; carrying
  them to the back; and then bringing them around the girdle they
  carry them to the fore part and again backward。 There are others who
  do not apply the bandage round the girdle; but carry the rounds of
  it by the perineum and anus; and along the spine; so as to compress
  the fracture。 To an inexperienced person these methods will appear not
  far from natural; but when tied; they will be found of no service; for
  they do not remain firm any length of time; even if the patient keep
  his bed; although in this position they answer best; and yet even when
  lying in bed; should he bend his leg; or should his trunk be bent; all
  the will be displaced; and; moreover; the bandaging is inconvenient;
  in as much as the anus is comprehended by it; and many turns of the
  bandage are crowded there in a narrow space。 And in the method with
  the girdle; the girdle cannot be so firmly girt around; but that the
  turns of the bandage force the girdle to ascend; and hence of
  necessity all the other bandages must be slackened。 He would seem to
  me to come nearest his purpose; although after all he effects but
  little; who would take a few turns round the girdle; few turns round
  the girdle; but would use the bandage principally to secure the former
  bandaging; for in this manner the bandages would be most secure; and
  would mutually assist one another。 Every thing now almost has been
  said which applies to fracture of the clavicle。 But this also should
  be known; that in fractures of the clavicle; it is the part attached
  to the breast which is uppermost; and that the piece attached to the
  acromion is the lowermost。 The cause of this is; that for the most
  part the breast can neither be depressed nor raised; there being but a
  slight movement of the joint at the breast; for the sternum is
  connected together on both sides with the spine。 The clavicle admits
  of most motion at the joint of the shoulder; and this arises from
  its connection with the acromion。 And; moreover; when broken; the part
  which is connected with the sternum flies upward; and is not easily
  forced downward; for it is naturally light; and there is more room for
  it above than below。 But the shoulder; the arm; and the parts
  connected with them; are easily moved from the sides and breast;
  and; on that account; they admit of being considerably elevated and
  depressed。 When; therefore; the clavicle is broken; the fragment
  attached to the shoulder inclines downward; for it inclines much
  more readily with the shoulder and arm downward than upward。 Matters
  being as I have stated; they act imprudently who think to depress
  the projecting end of the bone。 But it is clear that the under part
  ought to be brought to the upper; for the former is the movable
  part; and that which has been displaced from its natural position。
  It is obvious; therefore; that there is no other way of applying force
  to it (for the bandages no more force it to than they force it
  from); but if one will push the arm when at the sides as much as
  possible upward; so that the shoulder may appear as sharp as possible;
  it is clear that in this way it will be adjusted to the fragment of
  the bone connected with the breast from which it was torn。 If one then
  will apply a bandage; secundum artem; for the purpose of promoting a
  speedy cure; and will reckon everything else of no value; except the
  position as described; he will form a correct opinion of the case; and
  will effect a cure in the speediest and most appropriate manner。 It is
  of great importance; however; that the patient should lie in a
  recumbent posture。 Fourteen days will be sufficient if he keep
  quiet; and twenty at most。
  15。 But if the clavicle be fractured in the opposite manner (which
  does not readily happen); so that the fragment of bone connected
  with the breast is depressed; while the piece connected with the
  acromion is raised up and rides over other; this case does not require
  much management; for if the shoulder and arm be let go; the
  fragments of the bone will be adjusted to one another; and an ordinary
  bandage will suffice; and the callus will be formed in the course of a
  few days。
  16。 If the fracture be not thus; but if it incline either forward or
  backward; it may be restored to its natural position; by raising the
  shoulder with the arm as formerly described; and brought back to its
  natural place; when the cure will be speedily accomplished。 Most of
  the varieties of displacement may be rectified by raising the arm
  upward。 When the upper bone is displaced laterally or downward; it
  would favor the adaptation of the parts if the patient would lie on
  his back; and if some elevated substance were placed between the
  shoulder…blades; so that the breast may be depressed as much as
  possible upon the two sides; and if; while another person raised the
  arm extended along the sides; the physician; applying the palm of
  the one hand to the head of the bone; would push it away; and with the
  other would adjust the broken bones; he would thus reduce the parts
  most readily to their natural position。 But; as formerly stated; the
  upper bone (sternal fragment?) is rarely depressed downward。 In most
  cases; after the bandages have been applied; that position is
  beneficial in which the elbow is fixed to the same side; and the
  shoulder is kept elevated; but in certain cases; the shoulder is to be
  raised; as has been directed; and the elbow is to be brought forward
  to the breast; and the hand laid on the acromion of the sound side。 If
  the patient has the resolution to lie in bed; something should be
  placed so as to support the shoulder; and keep it as much elevated
  as possible。 But if he walk about; the arm should be slung in a shawl;
  which embraces the point of the elbow; and is passed round the neck。
  17。 When the elbow…joint is displaced or dislocated to the side or
  outward; while its sharp point (olecranon?) remains in the cavity of
  the humerus; extension is to be made in a straight line; and the
  projecting part is to be pushed backward and to the side。
  18。 In complete dislocations toward either side; extension is to
  be made as in bandaging fracture of the arm; for thus the rounded part
  of the elbow will not form an obstacle to it。 Dislocation; for the
  most part; takes place toward the sides (inwardly?)。 Reduction is to
  be effected by separating (the bones) as much as possible; so that the
  end (of the humerus) may not come in contact with the olecranon; and
  it is to be carried up; and turned round; and not forced in a straight
  line; and; at the same time; the opposite sides are to be pushed
  together; and propelled into their proper place。 It will further
  assist if rotation of the fore…arm be made at the elbow; sometimes
  turning it into a supine position; and sometimes into a prone。 The
  position for the treatment consists in keeping the hand a little
  higher than