Other formats

    TEI XML file   ePub eBook file  


    mail icontwitter iconBlogspot iconrss icon

War Surgery and Medicine

Bone Fragments

Bone Fragments

In the First World War any unattached piece of bone was removed as it was held that this would inevitably die and form a sequestrum and act as a focus of infection till it was removed. As already mentioned, the removal of larger fragments undoubtedly led to page 285 many cases of non-union, especially in the humerus and tibia. The removal of loose bone was recommended at the beginning of the Second World War until it was realised that there was grave danger of non-union resulting. The improvement in wound healing brought about by skilful surgery and the use of sulphonamides, and later of penicillin, made it possible that separated bone fragments might have a chance of survival. When delayed primary suture became a routine procedure and the wounds remained free from infection, the preservation of the bony fragments became the usual, and finally the regular, procedure. At that time bone chips were being utilised for the treatment of non-union, and it seemed anomalous to remove loose bone in fractures if bone chips could be introduced later and live. The success which attended the preservation of the loose fragments must as a rule have ensured solid union of the fractures. The preservation of bone fragments at the shoulder and at the elbow was strongly advocated, as stability in those positions was held to be preferable to the flail condition that might arise from removal of bone. The only bone then often requiring removal was the fractured or dislocated head of the radius: