REPORT

ON

DEFORMITIES AFTER FRACTURES.

BY

FRANK HASTINGS HAMILTON.

PART THIRD.

"If the prospect of that which remains to be done, after the labors of so many ages, tends to abate hope and discourage endeavor, yet it should be remembered that no man can determine the measure of success which may be connected with industrious research and zealous exertion."

PEARSON.

PREFACE.

WHEN I had nearly finished this last section of my Report on Deformities after Fractures, I found that its great length would compel me to seek some mode of abridgment. I withdrew, therefore, as being of the least value, all the chapters relating to the bones of the trunk, and also the chapter relating to the bones of the foot. I then set myself to work diligently to reduce the still enormous dimensions of the remainder. With what success you will see.

How is it possible, in a matter so entirely new, where everything has to be proven from the beginning, to dispense with the record of the cases, or to abridge their yet inconsiderable number? If the report admits of retrenchment, it is, I think, only in rejecting what relates to treatment; and upon this subject, the Committee of Publication must exercise its own judgment. I confess, however, that this seems to me to be the fruit of the plant, growing naturally upon it, and without which it would be only a very crooked and barren stalk.

Whether these results ought to be regarded as "successful," must be left to the judgment of every man to decide. For myself, I do not hesitate to call them so, when compared with almost any other department of mechanical surgery, and especially when viewed in connection with the extraordinary difficulties which constantly embarrass this branch of our art. Yet they are by no means "satisfactory," nor are they what we may hereafter hope to attain, nor, perhaps, are they what, in the hands of a few skilful surgeons, may even now be attained. I believe, however, that the average skill of the world, wherever the observations shall be carefully made, will present no better success; but not until those who think differently offer some better testimony than vague impressions, or dogmatic assertions, will their opinions merit respectful attention, or demand a serious reply.

It will surprise many, I have no doubt, that, in a report on Deformities after Fractures, I have made no mention of the means by which they may be remedied when they have actually occurred. I did not understand this to be the object for which the committee was appointed, but only to declare what these deformities usually were, in order that we might establish, if possible, the true prognosis in fractures. Yet, if this omission is to be regarded as a defect, I trust it will be somewhat repaired by the sections devoted to the treatment, which are intended to indicate how, in some measure, these deformities may be avoided. Moreover, it did not seem to me that I could add much to what has already been written upon this subject by another member of this association, Dr. Geo. W. Norris, of Philadelphia, whose paper, entitled On the Treatment of Deformities following Unsuccessfully Treated Fractures, was published in the Oct. number of the Amer. Journ. of Med. Sci., for 1842.

It is possible that wrong inferences may be drawn from the tables by those who do not observe particularly what is implied by the terms "perfect" and "imperfect." I have established for myself a standard by which to regulate the application of these terms, and which can be easily understood by a reference to the full record of the cases; but the standard is arbitrary, and probably would not be regarded as just by all surgeons. Indeed, it has frequently hap pened to me to examine broken limbs which have been carefully measured by other surgeons and found shortened one-quarter or one half, or even three-quarters of an inch, but which they have chosen to call "perfect." With such a standard as these gentlemen adopt, the proportion of perfect cases in my tables would have been very greatly increased, and, perhaps, art would have been less scandalized, but I know that truth would have been less faithfully vindicated.