The Home Medical Library Volume I Part 7

[Ill.u.s.tration: FIG. 17.

DRESSING FOR BROKEN FOREARM (SCUDDER).

Proper position of arm in sling; note that hand is unsupported with palm turned inward and thumb uppermost.]

Four weeks are required to secure firm union after this fracture. When the fracture is compound the same treatment should be employed as described under Compound Fracture of Leg, p. 116.

=FRACTURE OF THE WRIST; COLLES'S FRACTURE.=--This is a break of the lower end of the bone on the thumb side of the wrist, and much the larger bone in this part of the forearm. The accident happens when a person falls and strikes on the palm of the hand; it is more common in elderly people. A peculiar deformity results. A hump or swelling appears on the back of the wrist, and a deep crease is seen just above the hand in front. The whole hand is also displaced at the wrist toward the thumb side.

[Ill.u.s.tration: FIG. 18.

A BROKEN WRIST (SCUDDER).

Characteristic appearance of a "Colles's fracture"; note backward displacement of hand at wrist; also fork-shaped deformity.]

It is not usual to be able to detect abnormal motion in the case of this fracture, or to hear any grating sound on manipulating the part, as the ends of the fragments are generally so jammed together that it is necessary to secure a surgeon as soon as possible to pull them apart under ether, in order to remedy the existing "silver-fork"

deformity. (See Figs. 18, 19, 20, 21, 22.)

=Treatment.=--Until medical aid can be obtained the same sort of splints should be applied, and in the same way as for the treatment of fractured forearm. If the deformity is not relieved a stiff and painful joint usually persists. It is sometimes impossible for the most skillful surgeon entirely to correct the existing deformity, and in elderly people some stiffness and pain in the wrist and fingers are often unavoidable results.

[Ill.u.s.tration: FIG. 19.

FIG. 20.

FIG. 21.

FIG. 22.

FRACTURE OF THE WRIST (SCUDDER).

Above ill.u.s.trations show deformities resulting from a broken wrist; Figs. 19 and 20 the crease at base of thumb; Fig. 21 hump on back of wrist; Fig. 22 twisted appearance of hand.]

=FRACTURE OF BONE OF HAND, OR FINGER.=

_First Aid Rule.--Set fragments of bone in place by pulling with one hand on finger, while pressing fragments into position with other hand. Put on each side of bone a splint made of cigar box, padded with folded handkerchiefs, and retain in place with bandage wound about snugly. Put forearm and hand in sling._

This accident more commonly happens to the bones corresponding to the middle and ring finger, and occurs between the knuckle and the wrist, appearing as a swelling on the back of the hand. On looking at the closed fist it will be seen that the knuckle corresponding to the broken bone in the back of the hand has ceased to be prominent, and has sunken down below the level of its fellows. The end of the fragment nearer the wrist can generally be felt sticking up in the back of the hand.

[Ill.u.s.tration: FIG. 23.

A BROKEN FINGER (SCUDDER).

Note splint extending from wrist to tip of finger; also manner of applying adhesive plaster strips and pad in palm.]

If the finger corresponding to the broken bone in the back of the hand be pulled on forcibly, and the fragments be held between the thumb and forefinger of the other hand of the operator, pain and abnormal motion may be detected, and the ends of the broken bone pressed into place. A thin wooden splint, as a piece of cigar box, about an inch wide at base and tapering to the width of the finger should be applied to the palm of the hand extending from the wrist to a little beyond the finger tip, secured by strips of adhesive plaster, as in the cut, and covered by a bandage. The splint should be well padded, and an additional pad should be placed in the palm of the hand over the point of fracture. Three weeks are required for firm union, and the hand should not be used for a month.

It is usually easy to recognize a broken bone in a finger, unless the break is near a joint, when it may be mistaken for a dislocation.

Pain, abnormal motion, and grating between the fragments are observed.

If there is deformity, it may be corrected by pulling on the injured finger with one hand, while with the other the fragments are pressed into line. A narrow, padded wooden or tin splint is applied, as in the cut (p. 102), reaching from the middle of the palm to the finger tip.

Any existing displacement of the broken bone can be relieved by using pressure with little pads of cotton held in place by narrow strips of adhesive plaster where it is needed to keep the bone in line. The splint may be removed in two weeks and a strip of adhesive plaster wound about the finger to support it for a week or two more.

In fracture of the thumb, the splint is applied along the back instead of on the palm side.

=HIP FRACTURE.=

_First Aid Rule.--Put patient flat on back in bed, with limb wedged between pillows till surgeon arrives._

[Ill.u.s.tration: FIG. 24.

TREATING A BROKEN HIP (SCUDDER).

Note the manner of straightening leg and getting broken bone into line; also a.s.sistant carefully steadying the thigh.]

A fracture of the hip is really a break of that portion of the thigh bone which enters into the socket of the pelvic bone and forms the hip joint. It occurs most commonly in aged people as a result of so slight an accident as tripping on a rug, or in falling on the floor from the standing position, making a misstep, or while attempting to avoid a fall. When the accident has occurred the patient is unable to rise or walk, and suffers pain in the hip joint. When he has been helped to bed it will be seen that the foot of the injured side is turned out, and the leg is perhaps apparently shorter than its fellow. There is pain on movement of the limb, and the patient cannot raise his heel, on the injured side, from the bed. Shortening is an important sign.

With the patient lying flat on the back and both legs together in a straight line with the body, measurements from each hip-bone are made with a tape to the bony prominence on the inside of each ankle, in turn. One end of the tape is held at the navel and the other is swung from one ankle to the other, comparing the length of the two limbs.

Shortening of less than half an inch is of no importance as a sign of fracture. The fragments of broken bone are often jammed together (impacted) so that it is impossible to get any sound of grating between them, and it is very unwise to manipulate the leg or hip joint, except in the gentlest manner, in an attempt to get this grating. If the ends of the fragments become disengaged from each other it often happens that union of the break never occurs.

[Ill.u.s.tration: FIG. 25.

TREATMENT FOR FRACTURED HIP (SCUDDER).

Note method of holding splints in place with muslin strips; one above ankle, one below and one above knee, one in middle and one around upper part of thigh.]

The treatment simply consists in keeping the patient quiet on a hard mattress, with a small pillow under the knee of the injured side and the limb steadied on either side by pillows or cushions until a surgeon can be obtained. (See Thigh-bone Fracture.)

=THIGH-BONE FRACTURE.=

_First Aid Rule.--Prepare long piece of thin board which will reach from armpit to ankle, and another piece long enough to reach from crotch to knee, and pad each with folded towels or blanket._

_While one a.s.sistant holds body back, and another a.s.sistant pulls on ankle of injured side, see that the fragments are separated and brought into good line, and then apply the splints, a.s.sistants still pulling steadily, and fasten the splints in place with bandage, or by tying several cloths across at three places above the knee and two places below the knee._

_Finally, pa.s.s a wide band of cloth about the body, from armpit to hips, inclosing the upper part of the well-padded splint, and fasten it snugly. The hollow between splint and waist must be filled with padding before this wide cloth is applied._

In fracture of the thigh bone (between the hip and knee), there is often great swelling about the break. The limb is helpless and useless. There is intense pain and abnormal position in the injured part, besides deformity produced by the swelling. The foot of the injured limb is turned over to one side or the other, owing to a rolling over of the portion of the limb below the break. With both lower limbs in line with the body, and the patient lying on the back, measurements are made from each hip-bone to the prominence on the inside of either ankle joint. Shortening of the injured leg will be found, varying from one to over two inches, according to the overlapping and displacement of the fragments.

=Treatment.=--To set this fracture temporarily, a board about five inches wide and long enough to reach from the armpit to the foot should be padded well with towels, sheets, shawls, coats, blanket, or whatever is at hand, and the padding can best be kept in place by surgeon's adhesive plaster, bicycle tape, or strips of cloth.[8]

Another splint should be provided as wide as the thigh and long enough to reach along the back of the leg from the middle of the calf to the b.u.t.tock, and also padded in the same way. A third splint should be prepared in the same manner to go inside the leg, reaching from the crotch to the inside of the foot. Still a fourth splint made of a thin board as wide as the thigh, extending from the upper part of the thigh to just above the knee, is padded for application to the front of the thigh.

When these are made ready and at hand, the leg should be pulled on steadily but carefully straight away from the body to relax the muscles, an a.s.sistant holding the upper part of the thigh and pulling in the opposite direction. Then, when the leg has been straightened out and the thigh bone seems in fair line, the splints should be applied; the first to the outside of the thigh and body, the second under the calf, knee, and thigh; the third to the inside of the whole limb, and the fourth to the front of the thigh.

Wide pads should be placed over the ribs under the outside splint to fill the s.p.a.ce above the hips and under the armpit. Then all four splints are drawn together and held in place by rubber-plaster straps or strips of strong muslin applied as follows: one above the ankle; one below the knee; one above the knee; one in the middle of the thigh, and one around the upper part of the thigh. A wide band of strong muslin or sheeting should then be bound around the whole body between the armpits and hips, inclosing the upper part of the outside splint. The patient can then be borne comfortably upon a stretcher made of boards and a mattress or some improvised cushion. (See Figs.

24 and 25.)