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July 30, 1960


JAMA. 1960;173(13):1479-1482. doi:10.1001/jama.1960.73020310004019

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Dr. J. H. Dimon: A 51-year-old maintenance man was admitted to the emergency ward of the Massachusetts General Hospital in November, 1958, one hour after being struck by an automobile. He was conscious and not in shock. The right leg, which had been wrapped in a pillow splint, revealed an open transverse fracture of the midshaft of the right tibia and fibula (fig. 1 and 2). The bone was exposed from the anterior tibial tubercle to 2 cm. above the ankle joint, and the skin was sleeved circumferentially over this area. Sensation and circulation were present in the foot, and the dorsalis pedis pulse was palpable; the posterior tibial pulse was absent. The wound was grossly contaminated with clothing and dirt, and there was little bleeding from the area. No other significant injuries were present. The patient had always been in excellent health prior to the accident. He had had

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