The Home Medical Library Volume I Part 6

[Ill.u.s.tration: FIG. 9.

A BROKEN COLLAR BONE (SCUDDER).

Usual att.i.tude of patient with a fracture of this kind; note lowering and narrowed appearance of left shoulder.]

Fracture of the collar bone is one of the commonest accidents. The bone is usually broken in the middle third. A swelling often appears at this point, and there is pain there, especially on lifting the arm up and away from the body. It will be noticed that the shoulder, on the side of the injury, seems narrower and also lower than its fellow.

The head is often bent toward the injured side, and the arm of the same side is grasped below the elbow by the other hand of the patient and supported as in a sling. (See Fig. 9.) In examining an apparently broken bone _the utmost gentleness may be used_ or serious damage may result.

=Treatment.=--The best treatment consists in rest in bed on a hard mattress; the patient lying flat on the back with a small pillow between the shoulders and the forearm of the injured side across the chest. This is a wearisome process, as it takes from two to three weeks to secure repair of the break. On the other hand, if the forearm is carried in a sling, so as to raise and support the shoulder, while the patient walks about, a serviceable result is usually obtained; the only drawback being that an unsightly swelling remains at the seat of the break. To make a sling, a piece of strong cotton cloth a yard square should be cut diagonally from corner to corner, making two right-angled triangles. Each of these will make a properly shaped piece for a sling. (See Figs. 10 and 11.)

Fracture of the collar bone happens very often in little children, and is commonly only a partial break or splitting of the bone, not extending wholly through the shaft so as to divide it into two fragments, but causing little more than bending of the bone (the "green-stick fracture").

[Ill.u.s.tration: FIG. 10.

HOW TO MAKE A SLING (SCUDDER).

In Fig. 10 note three-cornered bandage; No. 2 end is carried over right shoulder, No. 1 over left, then both fastened behind neck; No. 3 brought over and pinned.]

[Ill.u.s.tration: FIG. 11.

HOW TO MAKE A SLING (SCUDDER).

The above ill.u.s.tration shows sling in position. It is made of cotton cloth a yard square cut diagonally from corner to corner.]

A fall from a chair or bed is sufficient to cause the accident. A child generally cries out on movement of the arm of the injured side, or on being lifted by placing the hands under the armpits of the patient. A tender swelling is seen at the point of the injury of the collar bone. A broad cotton band, with straps over the shoulders to keep it up, should encircle the body and upper arm of the injured side, and the hand of the same side should be supported by a narrow sling fastened above behind the neck.

=LOWER-JAW FRACTURE.=

_First Aid Rule.--Put fragments into place with your fingers, securing good line of his teeth. Support lower jaw by firmly bandaging it against upper jaw, mouth shut, using four-tailed bandage. (Fig. 12.)_

Fracture of the lower jaw is caused by a direct blow. It involves the part of the jaw occupied by the lower teeth, and is more apt to occur in the middle line in front, or a short distance to one side of this point. The force causing the break usually not only breaks the bone, but also tears the gum through into the mouth, making a compound fracture. There is immediate swelling of the gum at the point of injury, and bleeding. The mouth can be opened with difficulty.

The condition of the teeth is the most important point to observe.

Owing to displacement of the fragments there is a difference in the level of the teeth or line of the teeth, or both, at the place where the fracture occurs. Also one or more of the teeth are usually loosened at this point. In addition, unusual movement of the fragments may be detected as well as a grating sound on manipulation.

=Treatment.=--The broken fragments should be pressed into place with the fingers, and retained temporarily with a four-tailed bandage, as shown in the cut. Feeding is done through a gla.s.s tube, using milk, broths, and thin gruels. A mouth wash should be employed four times daily, to keep the mouth clean and a.s.sist in healing of the gum. A convenient preparation consists of menthol, one-half grain; thymol, one-half grain; boric acid, twenty grains; water, eight ounces.

[Ill.u.s.tration: FIG. 12.

BANDAGE FOR A BROKEN JAW (AMERICAN TEXT-BOOK).

Above cut shows a four-tailed bandage; note method of tying; one strip supports lower jaw; the other holds it in place against upper jaw.]

=SHOULDER-BLADE FRACTURE.=

_First Aid Rule.--There is no displacement. Bandage fingers, forearm, and arm of affected side, and put this arm in sling. Fasten slung arm to body with many turns of a bandage, which holds forearm against chest and arm against side._

Shoulder-blade fracture occasions pain, swelling, and tenderness on pressure over the point of injury. On manipulating the bone a grating sound may be heard and unnatural motion detected. The treatment consists in bandaging the forearm and arm on the injured side from below upward, beginning at the wrist; slinging the forearm bent at a right angle across the front of the body, suspended by a narrow sling from the neck, and then encircling the body and arm of the injured side from shoulder to elbow with a wide bandage applied under the sling, which holds the arm snugly against the side. This bandage is prevented from slipping down by straps attached to it and carried over each shoulder.

=ARM FRACTURE.=

_First Aid Rule.--Pad two pieces of thin board nine by three inches with handkerchiefs. Carefully pull fragments of bone apart, grasping lower fragment near elbow while a.s.sistant pulls gently on upper fragment near shoulder. Put padded boards (splints) one each side of the fracture, and wind bandage about their whole length, tightly enough to keep bony fragments firm in position. Put forearm and hand in sling._

In fracture of the arm between the shoulder and elbow, swelling and shortening may give rise to deformity. Pain and abnormal motion are symptoms, while a grating sound may be detected, but manipulation of the arm for this purpose should be avoided. The surface is apt soon to become black and blue, owing to rupture of the blood vessels beneath the skin.

The hand and forearm should be bandaged from below upward to the elbow. The bone is put in place by grasping the patient's elbow and pulling directly down in line with the arm, which is held slightly away from the side of the patient, while an a.s.sistant steadies and pulls up the shoulder. Then a wedge-shaped pad, long enough to reach from the patient's armpit to his elbow (made of cotton wadding or blanketing sewed in a cotton case) and about four inches wide and three inches thick at one end, tapering up to a point at the other, is placed against the patient's side with the tapering end uppermost in the armpit and the thick end down. This pad is kept in place by a strip of surgeon's adhesive plaster, or bandage pa.s.sing through the small end of the wedge, and brought up and fastened over the shoulder.

[Ill.u.s.tration: FIG. 13.

FIG. 14.

BANDAGE FOR BROKEN ARM (SCUDDER).

In Fig. 13 note splints secured by adhesive plaster; also pad in armpit; in Fig. 14 see wide bandage around body; also sling.]

While the arm is pulled down from the shoulder, three strips of well-padded tin or thin board (such as picture-frame backing) two inches wide and long enough to reach from shoulder to elbow, are laid against the front, outside, and back of the arm, and secured by encircling strips of surgeon's plaster or bandage. The arm is then brought into the pad lying against the side under the armpit, and is held there firmly by a wide bandage surrounding the arm and entire chest, and reaching from the shoulder to elbow. It is prevented from slipping by strips of cotton cloth, which are placed over the shoulders and pinned behind and before to the top of the bandage. The wrist is then supported in a sling, not over two inches wide, with the forearm carried in a horizontal position across the front of the body.

Firm union of the broken arm takes place usually in from four to six weeks. (See Figs. 13 and 14.)

=FOREARM FRACTURE.=

_First Aid Rule.--Set bones in proper place by pulling steadily on wrist while a.s.sistant holds back the upper part of the forearm. If unsuccessful, leave it for surgeon to reduce after "period of inaction" comes, a few days later, when swelling subsides. If successful, put padded splints (pieces of cigar box padded with handkerchiefs) one on each side, front and back, and wind a bandage about whole thing to hold it immovably._

Two bones enter into the structure of the forearm. One or both of these may be broken. The fracture may be simple or compound,[7] when the soft parts are damaged and the break of the bone communicates with the air, the ends of the bone even projecting through the skin.

In fracture of both bones there is marked deformity, caused by displacement of the broken fragments, and unusual motion may be discovered; a grating sound may also be detected but, as stated before, manipulation of the arm should be avoided.

[Ill.u.s.tration: FIG. 15.

SETTING A BROKEN FOREARM (SCUDDER).

See manner of holding arm and applying adhesive plaster strips; one splint is shown, another is placed back of hand and forearm.]

When only one bone is broken the signs are not so marked, but there is usually a very tender point at the seat of the fracture, and an irregularity of the surface of the bone may be felt at this point. If false motion and a grating sound can also be elicited, the condition is clear. The broken bones are put into their proper place by the operator who pulls steadily on the wrist, while an a.s.sistant grasps the upper part of the forearm and pulls the other way. The ends of the fragments are at the same time pressed into place by the other hand of the operator, so that the proper straight line of the limb is restored.

[Ill.u.s.tration: FIG. 16.

FRACTURE OF BOTH BONES IN FOREARM (SCUDDER).

This cut shows the position and length of the two padded splints; also method of applying adhesive plaster.]

After the forearm is set, it should be held steadily in the following position while the splints are applied. The elbow is bent so that the forearm is held at right angles with the arm horizontally across the front of the chest with the hand extended, open palm toward the body and thumb uppermost. The splints, two in number, are made of wood about one-quarter inch thick, and one-quarter inch wider than the forearm. They should be long enough to reach from about two inches below the elbow to the root of the fingers. They are covered smoothly with cotton wadding, cotton wool, or other soft material, and then with a bandage. The splints are applied to the forearm in the positions described, one to the back of the hand and forearm, and the other to the palm of the hand and front of the forearm.

Usually there are s.p.a.ces in the palm of the hand and front of the wrist requiring to be filled with extra padding in addition to that on the splint. The splints are bound together and to the forearm by three strips of surgeon's adhesive plaster or bandage, about two inches wide. One strip is wound about the upper ends of the splints, one is wrapped about them above the wrist, and the third surrounds the back of the hand and palm, binding the splints together below the thumb.

The splints should be held firmly in place, but great care should be exercised to use no more force in applying the adhesive plaster or bandage than is necessary to accomplish this end, as it is easy to stop the circulation by pressure in this part. There should be some spring felt when the splints are pressed together after their application. A bandage is to be applied over the splints and strips of plaster, beginning at the wrist and covering the forearm to the elbow, using the same care not to put the bandage on too firmly. The forearm is then to be held in the same position by a wide sling, as shown above. (See Figs. 15, 16, 17.)