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

118 INJURIES OF NERVES.
coufoiinded, so to speak, iu a mass of peripheral callus."
"At this level the nerve was compressed as by a ligature,
and measured three millimetres in diameter, while above,
the swollen trunk attained one centimetre in width, and
below this point was only slightly enlarged. A little
lower it was of normal size, although
still
lying for
fifteen to twenty millimetres of its
length in the heart of
the callus." The osseous point was removed, and the nerve
left resting in a shutter, broadlv hollowed for it in the
bone, from which the periosteum was removed. Nearly
perfect recovery took place. «
Besides this interestino- historv of bold and sao-acious
surgical interference, there are but few instances of nerve
injury from the pressure of callus. An instructive case,
which occurred in the practice of Mr. Hilton, is related
an instance
by Sir James Paget,* and Swan has reported
somewhat similar in character. In the former case, a
man who had a fracture of the lower end of the radius
had his median nerve compressed by a large mass of
callus. His thumb and first and second fingers ulcerated,
and the ulcers resisted all treatment until the wrist was
kept bent in such a way as to relieve the nerve from pressure.
The ulcers returned whenever the hand was allowed
to assume its former position.
Gurlt has also related an undoubted instance of callus
but how rare these accidents are may be gath-
pressure ;
ered from the fact that neither Hamilton nor Malgaio-ne
relates a single example. I have seen three cases, at least,
of extensive callus following gunshot wounds of bone, in
which there must have been imprisonment of nerve trunks.
In one only, a wound of the forearm, was there any
evidence of pressure, and in this case the sj-mptoms were
most probably due to injury produced at the time of the
wounding.
* Surgical Pathology, vol. i. p. 43.