The Home Medical Library Volume I Part 8

When the patient can be put immediately to bed after the injury, and does not have to be transported, it is only necessary to apply the outer, back, and front splints, omitting the inner splint. It is necessary for the proper and permanent setting of a fractured thigh that a surgeon give an anaesthetic and apply the splints while the muscles are completely relaxed. It is also essential that the muscles be kept from contracting thereafter by the application of a fifteen- or twenty-pound weight to the leg, after the splints are applied, but it is possible to outline here only the proper first-aid treatment.

=KNEEPAN FRACTURE.=

_First Aid Rule.--Pain is immediate and intense. Separated fragments may be felt at first. Swelling prompt and enormous. Even if not sure, follow these directions for safety._

_Prepare splint: thin board, four inches wide, and long enough to reach from upper part of thigh to just above ankle. Pad with folded piece of blanket or soft towels. Place it behind leg and thigh; carefully fill s.p.a.ce behind knee with pad; fasten splint to limb with three strips of broad adhesive plaster, one around upper end of splint, one around lower end, one just below knee._

_Lay large flat, dry sponge over knee thus held, and bandage this in place. Keep sponge and bandage wet with ice water. If no sponge is available, half fill rubber hot-water bottle with cracked ice, and lay this over knee joint. Put patient to bed._

Fracture of kneepan is caused either by direct violence or muscular strain. It more frequently occurs in young adults. Immediate pain is felt in the knee and walking becomes impossible; in fact, often the patient cannot rise from the ground after the accident. Swelling at first is slight, but increases enormously within a few hours.

Immediately after the injury it may be possible to feel the separate broken fragments of the kneepan and to recognize that they are separated by a considerable s.p.a.ce if the break is horizontally across the bone.

[Ill.u.s.tration: FIG. 26.

A BROKEN KNEEPAN (SCUDDER).

A padded splint, supporting knee, is shown reaching from ankle to thigh. Note number and location of adhesive plaster strips.]

Nothing can be done to set the fracture until the swelling about the joint has been reduced, so that the first treatment consists in securing immediate rest for the kneejoint, and immobility of the fragments. A splint made of board, about a quarter of an inch thick and about four inches wide for an adult, reaching from the upper part of the thigh above to a little above the ankle below, is applied to the back of the limb and well padded, especially to fill the s.p.a.ce behind the knee. The splint is attached to the limb by straps of adhesive plaster two inches and a half wide; one around the lower end of the splint, one around the upper part, and the third placed just below the knee. To prevent and arrest the swelling and pain, pressure is then made on the knee by bandaging.

One of the best methods (Scudder's) is to bind a large, flat, dry sponge over the knee and then keep it wet with cold water; or to apply an ice bag directly to the swollen knee; a splint in either case being the first requisite. The patient should of course be put to bed as soon as possible after the accident, and should lie on the back with the injured leg elevated on a pillow with a cradle to keep the clothes from pressing on the injured limb. (See cut, p. 110.)

=FRACTURE OF LEG BONES, BETWEEN KNEE AND ANKLE.=

_First Aid Rule.--Handle very carefully; great danger of making opening to surface. Special painful point, angle or new joint in bone, disability, and grating felt will decide existence of break. Let a.s.sistant pull on foot, to separate fragments, while you examine part of supposed break. If only one bone is broken, there may be no displacement._

_Put patient on back. While two a.s.sistants pull, one on ankle and one on thigh at knee, thus separating fragments, slide pillow lengthwise under knee, and, bringing its edges up about leg, pin them snugly above leg._

_Prepare three pieces of thin wood, four inches wide and long enough to reach from sole of foot to a point four inches above knee. While a.s.sistants pull on limb again, as before, put one splint each side and third behind limb, and with bandage or strips of sticking plaster fasten these splints to the leg inclosed in its pillow as tight as possible._

In fracture of the leg between the knee and ankle we have pain, angular deformity or an apparent false joint in the leg, swelling and tenderness over the seat of fracture, together with inability to use the injured leg. Two bones form the framework of the leg; the inner, or s.h.i.+nbone, the sharp edge of which can be felt in front throughout most of its course, being much the larger and stronger bone. When both bones are broken, the displacement of the fragments, abnormal motion and consequent deformity, are commonly apparent, and a grating sound may be heard, but should not be sought for.

[Ill.u.s.tration: FIG. 27.

FRACTURE OF BOTH LEG BONES (SCUDDER).

This cut shows the peculiar deformity in breaks of this kind; see position of kneepan; also prominence of broken bone above ankle.]

An open wound often communicates with the break, making the fracture compound, a much more serious condition. To avoid making the fracture a compound one, during examination of the leg, owing to the sharp ends of the bony fragments, the utmost gentleness should be used.

Under no circ.u.mstances attempt to move the fragments from side to side, or backward and forward, in an effort to detect the grating sound often caused by the ends of broken bones. The greatest danger lies in the desire to do too much. We again refer the reader to First Aid Rule 1.

[Ill.u.s.tration: FIG. 28.

BANDAGE FOR BROKEN LEG (SCUDDER).

Note the pillow brought up around leg and edges pinned together; also length and method of fastening splint with straps.]

When one bone is broken there may be only a point of tenderness and swelling about the vicinity of the break and no displacement or grating sound. When in doubt as to the existence of a fracture always treat the limb as if a fracture were present. "Black and blue"

discoloration of the skin much more extensive than that following sprain will become evident over the whole leg within twenty-four hours.

=Treatment.=--When a surgeon cannot be obtained, the following temporary pillowdressing, recommended by Scudder in his book on fractures, is one of the best. With the patient on his back, the leg having been straightened and any deformity removed as far as possible by grasping the foot and pulling directly away from the body while an a.s.sistant steadies the thigh, a large, soft pillow, inclosed in a pillowcase, is placed under the leg. The sides of the pillow are brought well up about the leg and the edges of the pillowcase are pinned together along the front of the leg.

Then three strips of wood about four inches wide, three-sixteenths to a quarter of an inch thick, and long enough to reach from the sole of the foot to about four inches above the knee, are placed outside of the pillow along the inner and outer aspects of the leg and beneath it. The splints are held in place, with the pillow as padding beneath, by four straps of webbing (or if these cannot be obtained, by strips of stout cloth, adhesive plaster, or even rope); but four pads made of folded towels should be put under the straps where they cross the front of the leg where little but the pillowcase overlaps. These straps are applied thus: one above the knee, one above the ankle, and the other two between these two points, holding all firmly together.

This dressing may be left undisturbed for a week or even ten days if necessary. (See Figs. 27 and 28.)

The leg should be kept elevated after the splints are applied, and steadied by pillows placed either side of it. From one to two months are required to secure union in a broken leg in adults, and from three to five months elapse before the limb is completely serviceable. In children the time requisite for a cure is usually much shorter.

=ANKLE-JOINT FRACTURE.=

_First Aid Rule.--One or both bones of leg may be broken just above ankle. Foot is generally pushed or bent outward. Prepare two pieces of thin wood, four inches wide and long enough to go from sole of foot to just below knee:--the splints. Pad them with folded towels or pieces of blanket._

_While a.s.sistants pull bones apart gently, one pulling on knee, other pulling on foot and turning it straight, apply the splints, one each side of the leg._

A fracture of the ankle joint is really a fracture of the lower extremities of the bones of the leg. There are present pain and great swelling, particularly on the inner side of the ankle at first, and the whole foot is pushed and bent outward. The bony prominence on the inner side of the ankle is unduly marked. The foot besides being bent outward is also displaced backward on the leg. This fracture might be taken for a dislocation or sprain of the ankle. Dislocation of the ankle without fracture is very rare, and when the foot is returned to its proper position it will stay there, while in fracture the foot drops back to its former displaced state. In sprained ankle there are pain and swelling, but not the deformity caused by the displacement of the foot.

This fracture may be treated temporarily by returning the foot to its usual position and putting on side splints and a back splint, as described for the treatment of fracture of the leg.

=COMPOUND OR OPEN FRACTURE OF THE LEG.=--This condition may be produced either by the violence which caused the fracture also leading to destruction of the skin and soft parts beneath, or by the end of a bony fragment piercing the muscles and skin from within. In either event the result is much more serious than that of an ordinary simple fracture, for germs can gain entrance through the wound in the skin and cause inflammation with partial destruction or death of the part.

=Treatment.=--Immediate treatment is here of the utmost value. It is applicable to open or compound fracture in any part of the body. The area for a considerable distance about the wound, if covered with hair, should be shaved. It should then be washed with warm water and soap by means of a clean piece of cotton cloth or absorbent cotton.

Then some absorbent cotton or cotton cloth should be boiled in water in a clean vessel for a few minutes, and, after the operator has thoroughly washed his hands, the boiled water (when sufficiently cool) should be applied to the wounded area and surrounding parts with the boiled cotton, removing in the most painstaking way all visible and invisible dirt. By allowing some of the water to flow over the wound from the height of a few feet this result is favored. Finally some of the boiled cotton, which has not been previously touched, is spread over the wound wet, and covered with clean, dry cotton and bandaged.

Splints are then applied as for simple fracture in the same locality (p. 113). If a fragment of bone projects through the wound it may be replaced after the cleansing just described, by grasping the lower part of the limb and pulling in a straight line of the limb away from the body, while an a.s.sistant holds firmly the upper part of the limb and pulls in the opposite direction. During the whole process neither the hands of the operator nor the boiled cotton should come in contact with anything except the vessel containing the boiled water and the patient.

FOOTNOTES:

[5] The engravings ill.u.s.trating the chapters on "Fractures" and "Dislocations" are from Buck's "Reference Handbook of Medical Science," published by William Wood & Co., New York; also, Scudder's "Treatment of Fractures" and "American Text-Book of Surgery,"

published by W. B. Saunder's Company, Philadelphia.

[6] It should be distinctly understood that the information about fractures is not supplied to enable anyone to avoid calling a surgeon, but is to be followed only until expert a.s.sistance can be obtained and, like other advice in this book, is intended to furnish first-aid information or directions to those who are in places where physicians cannot be secured.

[7] For treatment of compound fracture, see Compound Fracture of Leg (p. 116).

[8] This method follows closely that recommended by Scudder, in his book "The Treatment of Fractures."

CHAPTER V

=Dislocations=

_How to Tell a Dislocation--Reducing a Dislocated Jaw--Stimson's Method of Treating a Dislocated Shoulder--Appearance of Elbow when Out of Joint--Hip Dislocations--Forms of Bandages._