पञ्चदशोऽध्यायः । अथातो भग्नानां निदानं व्याख्यास्यामः,
यथोवाच भगवान् धन्वन्तरिः ॥ १ ॥
Now we shall discourse on the Nidana of Bhagna (fractures and dislocations etc. of bones). 1
पतनपीडनप्रहाराक्षेपणव्यालमृगदशनप्रभृतिभिरभिघातविशेषैरनेकविधमस्थनां भग्नमुपदिशन्ति ।
तत् तु भङ्गजातमनुसार्यमाणं द्विविधमेवोत्पद्यतेसन्धिमुक्तं काण्डभग्नञ्च ॥ २ ॥
Various kinds of fracture may be caused from a variety of causes, such as by a fall, pressure, blow, violent jerking or by the bites of ferocious beasts etc. These cases may be grouped under the two main subdivisions such as Sandhi Mukta (dislocation) and Kanda – Bhagna (fracture of a kanda). 2
तत्र सन्धिमुक्तम्- उत्पिष्टं विश्लिष्टं विवर्त्तितमवक्षिप्तमतिक्षिप्तं तिर्यक्षिप्तमिति षड्विधम् ।। ३ ।।
Cases of Sandhi-mukta ( dislocation ) may be divided into six different types such as the Utplista, Vislista, Vivartita, Avaksipta, Atiksipta and Tiryakksipta 3
तत्र प्रसारणाकुञ्चनविवर्त्तनाक्षेपणाशक्तिरुग्ररुजत्वं स्पर्शासहत्वञ्चेति सामान्यं सन्धिमुक्तलक्षणमुक्तम् ।। ४॥
General features of a dislocation : Incapability of extension, flexion, movement, circumduction and rotation (immobility, considered in respect of the natural movements of the joints), of the dislocated limb, which becomes extremely painful and cannot bear the least touch. These are said to be the general symptoms of a dislocation. 4
विशेषेणोत्पिष्टे सन्धावुभयतः शोफो वेदनाप्रादुर्भावो विशेषतश्च नानाप्रकारा वेदना रात्रौ प्रादुर्भवन्ति । विश्लिष्टेऽल्पः शोफो वेदनासातत्यं सन्धिविक्रिया च । विवर्तिते तु सन्धि पार्श्वापगमनाद् विषमाङ्गता वेदना च। अवक्षिप्ते सन्धिविश्लेषस्तीव्ररुजत्वञ्च | अतिक्षिप्ते द्वयोः सन्ध्यस्थ्नोरतिक्रान्तता वेदना च । तिर्यक्षिप्ते त्वेकास्थिपार्श्वापगमनमत्यर्थं वेदना चेति ॥ ५ ॥
Diagnostic symptoms of a dislocation : In case of a friction of a joint by two articular extremeties (Utplista) a swelling is found to appear on either side of the articulation attended with a variety of pain at night. A little swelling accompanied by a constant pain and disordered function of the dislocated joint, marks the case of simplelooseness (Vislista) of the articulaton; while pain and unevenness of the joint owing to the displacement of the connected bones distinguish a case of Vivartita (lateral displacement). An excruciating pain, and looseness of the dislocated bone are the symptoms which characterise a case in which a dislodged bone is seen to drop or hang down from its joint (Avaksipta). In a case of abnormal projection (Ati-ksipta), the dislocated bone is removed away from its joint which becomes extremely painful. A case of oblique dislocation (Tiryak-ksipta) is marked by the projection or displacement of the bone on one side accompanied by a sort of intolerable pain. 5
काण्डभग्नमत ऊर्ध्वं वक्ष्यामःकर्कटकमश्वकर्णं चूर्णितं पिच्चितमस्थिच्छल्लितं काण्डभग्नं मज्जानुगतमतिपातितं वक्रं छिन्नं पाटितं स्फुटितमिति द्वादशविधम् ।। ६ ।।
Different kinds of Kanda Bhagna: Now we shall describe the Kanda-Bhagna (fracture etc.). Frcatures may be divided into twelve different kinds which are known as, Karkataka, Asvakarna, Curnita, Piccita, Asthi-cchallita, Kanda-bhagna, Majjanugata, Atipatita, Vakra, Chinna, Patita and Sphutita. 6
श्वयथुबाहुल्यं स्पन्दन विवर्त्तनस्पर्शासहिष्णुत्वमवपीड्यमाने शब्दः
स्त्रस्ताङ्गता विविधवेदनाप्रादुर्भावः सर्वास्ववस्थासु न शर्मलाभ इति समासेन काण्डभग्नलक्षणमुक्तम् ।। ७ ।।
General Symptoms of Kanda-bhagna: A violent swelling (about the seat of fracture) with throbbings or pulsations, abnormality in the position (of the fractured limb), which cannot bear the least touch, crepitus under pressure, a looseness or dropping of the limb, the presence of a variety of pain and a sense of discomfort in all positions are the indications which generally mark all kinds of fracture (Kandabhagna). 7
विशेषतस्तु संमूढमुभयतोऽस्थि मध्ये भग्नं ग्रन्थिरिवोन्नतं कर्कटकम् । अश्वकर्णवदुद्गतमश्वकर्णकम् । स्पृश्यमानं शब्दवच्चूर्णितमवगच्छेत् । पिच्चितं पृथुतां गतमनल्पशोफम् । पार्श्वयोरस्थि हीनोद्गतमस्थिच्छल्लितम् । वेल्लते प्रकम्पमानं काण्डभग्नम् । अस्थ्यवयवोऽस्थिमध्यमनुप्रविश्य मज्जानमुन्नह्यतीति मज्जानुगतम् । अस्थि निःशेषतश्छिन्नमतिपातितम् । आभुग्नमविमुक्तास्थि वक्रम् | अन्यतरपार्श्वावशिष्टं छिन्नम्। पाटितमणुबहुविदारितं वेदनावच्च शूकपूर्णमिवाधूमातं विपुलं विस्फुटीकृतं स्फुटितमिति । तेषु चूर्णितच्छिन्नातिपातितमज्जानुगतानि कृच्छ्रसाध्यानि, कृशवृद्धबालानां क्षतक्षीणकुष्ठश्वासिनां सन्ध्युपगतञ्चेति ।। ८॥
Diagnostic Symptoms: The case where a fractured bone, pressed or bent down at its two articular extremities, bulges out at the middle so as to resemble the shape of a knot (Granthi), is called Karkata. The case where the fractured bone projects upward like the ear of a horse is called Asvakarna. The fractured bone is found to be shattered into fragments in a case of the Curnita or comminuted kind which can be detected both by palpation and crepitation. A smashed condition of the fractured bone marks a case of the Piccita kind which is often found to be marked by a great swelling. The case where the covering or skin of the bone (periosteum) is cast or splintered off is called the Asthi-cchallita. The case where the completely broken or severed bones are found to project through the local skin, trembles by movement is called Kanda-bhagna (compound). The case where a fragment of the fractured or broken bone is found to pierce into the bone and dig out the marrow, is called Majjanugata, (Impacted fracture). The case where the fractured bone droops or hangs down is called Ati-patita. The case where the unloosened bone (from its position) is bent down in the form of an arch is called Vakra. The case where only one articular extremity of the bone is severed is called Chinna. The case where the bone is slightly fractured and pierced with a large number of holes, is called Patita, an excruciating pain being the leading indication. The case where the bone largely cracked and swollen becomes painful as if stuffed with the bristles of a Suka insect is called Sphutita (Green-stick fracture ). Of the several kinds of fracture, cures are effected with extreme difficulty in a case of the Curnita, Chinna, Ati-patita or Majjanugatakind. A case of displacement or laxation occuring in a child or in an old or weak patient or in one suffering from asthma (Svasa) or from any cutaneous affection (Kustha) or Ksata Ksina disease is difficult to cure. 8
भवन्ति चात्र । भिन्नं कपालं कट्यांतु सन्धिमुक्तं तथा च्युतम् । जधनं प्रतिपिष्टञ्चवर्जयेत् तच्चिकित्सकः ।। ९ ।।
असंश्लिष्टं कपालंतु ललाटे चूर्णितञ्च यत् । भग्नं स्तनान्तरे शङ्ख पृष्ठे मूर्ध्नि च वर्जयेत् ।। १० ।।
आदितो यच्च दुर्जातमस्थि सन्धिरथापि वा। सम्यग्यमि-(संहि)-तमप्यस्थि दुर्व्यासादुर्निबन्धनात् ।
सङ्ग्रोभावाऽपि यद् गच्छेद् विक्रियां तत् तु वर्जयेत् ।। ११ ।।
Memorable verses : The following cases are to be given up as hopeless — viz fracture of the pelvic bone (or of bones that are of this description, wherever they may be situated); dislocation of the pelvic joints; compound fracture of the thigh bone or of the flat bones); fracture into small pieces of the frontal bone or its dislocation; simple fracture of the chest-bones, back-bone and temporal and cranial bones. If the dislocations and fractures be improperly set from the outset (Adito)¹ or if the union be anyhow disturbed there is no hope for recovery. 9-11
1. The word Adito may be taken into the sense of congenital mal-formation which is beyond remedy.
मध्यस्य वयसोऽवस्थास्तिस्त्रो याः परिकीर्त्तिताः । तत्र स्थिरो भवेज्जन्तुरुपक्रान्तो विजानता ।। १२ ।।
If fractures happen at any time of the first three stages of adult life which has been described before (vide Sutrasthana Chap. XXXV.) and if they are set up by an able surgeon they have a great chance of being united. 12
तरुणास्थीनि नम्यन्ते भज्यन्ते नलकानि तु । कपालानि विभिद्यन्ते स्फुटन्ति रुचकानि च ॥ १३ ॥
The cartilaginaus bones bend, the tubular bones break the flat bones get fissured and Ruchaka¹ (small bones) get cracked. 13
इति सुश्रुतसंहितायां निदानस्थाने भग्ननिदानं नाम पञ्चदशोऽध्यायः ।। १५ ।।
Thus ends the fifteenth Chapter of the Nidana Sthana in the Susruta Samhita which treats of the Nidana of dislocation and fractures.
