Injuries of nerves and their consequences - Reflex Sympathetic ...

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106 INJURIES OF NERVES.
A number of such cases were seen in the United States
Hospital for I^ervonsDiseases, all of them fromball wounds.
Two of these proved altogether hopeless, as must usually
be the case with nerve wounds the result of bone fractures
from missiles.
As regards the femur, lesions grave enough to break
and displace fragments from one end of the bone so as to
injure a great nerve, are rarely seen except as the result
of machine or railway injuries. Mr. Swan reports a case
of double fracture of the neck of the femur,— the patient
surviving two months. There was intense pain, which
proved to have been due to direct injury of the sciatic
nerve by the broken bone.*
Smithf details a curious case of double fracture of both
bones of the leo-, in which the anterior tibial nerve had
been torn across, occasioning intense neuralgia and subsequently
demanding amputation. Alquie, quoted by
Reuillet,t relates a somewhat similar history of injur}' to
the same nerve, which I have once seen wounded by a
ball fracture, where apparently the lesion had been due
to a fras^ment of bone driven ao;aiust the nerve.
This case
occurred in the Filbert Street United States Hospital,
and was discharged uncured, and, indeed, unrelieved.
I have not met, either in practice or in my reading,
with cases of injury to the intercostal nerves from fractured
ribs. Yet it seems quite possible that where this
accident has been due to direct force such a complication
might well occur. The best collection of cases of fracture
resulting in nerve wounds is to be met with in an excellent
paper by Mr. Callender.§
The sole remaining instance of neural injury of the
* Swan, op. cit
, p. 108.
t Dublin Journ. jMed. Sci., vol. XV. p. 234. 1839.
X Bull. Gen. de Therap. 1848.
g St. Bartholomew's Hospital Reports, vol. vi., 1870, p. 33 et seq.