THE existence of a fracture is to be known by the symptoms. These are pain, swelling, deformity from the limb bending to one side, sometimes shortening of the limb, or loss of power to use it, and a crepitus or grating sound or sensation from the rubbing of the ends of the broken bone together. There are several kinds of fractures. They are
The Transverse Fracture, which is directly across the bone.
The Oblique Fracture, which runs from side to side, in an oblique direction.
The Longitudinal Fracture, which runs lengthwise of the bone.
A Simple Fracture is one in which the bone is broken simply, with. out any wound of the flesh with it.
A Compound Fracture consists of a simple fracture, and of an external wound in addition, caused by pushing the end of the broken bone through the flesh.
A Complicated Fracture is one in which, besides the breaking of the bone, there is the dislocation of a joint, the wounding of an artery, the extensive tearing of the soft parts, or the wounding of the bowels or some other internal organ.
A Comminuted Fracture is one in which the bone is broken into several pieces.
Treatment of Fractures. When a bone is broken, the first thing to be done is to get the injured person to his home, or to the nearest house. To do this in a rough or careless way might add much to his sufferings.
If it be an arm which is broken, let it be placed in a broad sling, extending from the elbow to the fingers. In this condition the patient, if in tolerable health, and the distance is not great, will find it easier to walk home, than to bear the jolting of a carnage.
If the leg or the thigh be broken, then a hurdle of some sort (Fig.156), must be obtained as soon as possible, and, being covered with straw, or blankets, or garments, the patient should be gently lifted upon it by just persons enough to raise him easily
from the ground. This should now be carried by four persons, two at each end, moving with great gentleness, and. keeping exact step with each other. If these persons
take hold of the ends of two poles, laid under the hurdle, they win
fiud they can carry it much more easily. If no hurdle be at hand,
let four poles, two long ones, and two short ones, be laid across each
other at right angles, and fasten together with nails or strings. Then
lay upon these an old door, or some loose boards; and the injured
person may be easily carried upon this temporary structure. A
blanket fastened upon four poles, in the manner of a cotbed, will
answer a good purpose.
Having placed the patient upon the hand carriage, bring the sound limb and the broken one snug together, and tie them to each other with two or three pocket handkerchiefs; this will support the broken limb, and prevent its being shaken about and injured by motion. In doing this, the limb should be laid as near as possible in the natural position, so that the bones may not get out of place, and their ends get pushed through the flesh.
The Reduction, or Setting of the Fracture, is the first thing to be done. By this is meant the bringing of the end of the broken bone together, and adjusting them to each other in their natural position. This is done by what Surgeons call extension, counter extension and coaptation.
Extension means taking hold of the limb below the fracture and pulling from the body.
Counter Extension is pulling above the fracture towards the body. These opposite pulling are done at the same time to overcome the force of the muscles, which contract, and draw the ends of the bone by each other and shorten the limb.
Sometimes no extension or counter extension is necessary, the ends of the broken bone not being pulled out of their place. When the pulling is necessary, it should be gentle and steady.
Modern surgery has developed two simple mechanical means of making extension and counter extension for the purpose of overcoming muscular spasm which rarely fail. One is by the use of elastic rubber bands, and the other by the attachment to the limb of a cord running over a pulley at the foot of the bed and sustaining a suitable weight. The method of employing these will be given in detail in connection with special fractures.
Coaptation means adjusting the ends of the bone to each other.
The next thing is to provide for keeping the ends of the broken bone steadily in contact, so that nature may have a fair chance to unite them.
To secure this object, mechanical contrivances are used, which are simple, and may always be bad without difficulty.
They consist of linen bandages, about the breadth of four fingers, and from four to ten yards long; and pads, made of old woolen cloth or blankets lightly quilted together, or pillow cases filled with tow, or chaff, or cut straw, or even leaves; and of splinter, made of clapboards, or thick shingles, four fingers wide, and in length corresponding with that of the broken limb; or wheat straw laid side by side, and quilted into a piece of cloth to prevent them moving about. A very useful splint may be made from the fresh bark of trees.
The pads are to be placed under the splints, to prevent injuries to the skin; and the bandages to be bound over the whole.
A great joint is to have the splints accurately adapted in each case, and the ability to affect this is an important element of success in this branch of surgery. Wood may be generally cut into suitable shape, but it is perhaps easier to use molded splints of leather, felt, gutta¬percha, or shellac cloth. The starched or plaster bandage or gummed paper may be effectively used; and with a proper pair of shears, sheets of tin or zinc may be cut into splints, which will answer admirably. Woven iron wire splints are highly recommended.
For some hours after a limb is broken, the parts continue to swell, and if bound up immediately with the pads, splints, etc., much needless pain will be occasioned. It is best, therefore, not to put these on under two or three days, but merely to lay the limb in a natural position, and perhaps lightly bind one splint to it. Broken ribs and collar bones are exceptions, and should be bound up immediately.
A broken arm lies easiest half bent, upon a pillow; the thigh or leg, upon the outside, with the knee bent.
When the apparatus is once adjusted, the less it is meddled with the better.
In fractures of the shoulder or arm, a sling is a contrivance of great importance. This, if well made and adjusted, keeps the broken bone in its place, and at the same time allows the patient to take some exercise by walking about.
Besides the above contrivances, there is the double inclined plane
(Fig. 157) for giving the leg the advantage of a bent position. There are also fracture boxes (Fig. 158), and fracture cradle, the latter to keep the bed clothes lifted away from the painful limb. Fracture beds are now brought to great perfection, and one should, if possible, be procured when the patient is likely to be confined a long time with a compound fracture. The fracture box represented by Fig. 158, may be made from thin boards, by any carpenter. It has a hinge at the knee to enable it to fulfill the double purpose of a double inclined plane and a fracture box.
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