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Fractures (End of the finger over)

end of the finger over the back of the hand. It may sometimes be proper to have two additional splints for the sides of the finger.

Fractures of the Ribs.

When, after a fall or blow, the patient complains of a pricking in his side, we may suspect a rib is broken. It is ascertained by placing the tips of two or three fingers on the spot where the pain is, and desiring the patient to cough, when the grating sensation will be felt. All that is necessary is to pass a broad bandage round the chest, so tight as to prevent the motion of the ribs in breathing, and to observe a low diet.

Fractures of the Thigh.

This bone is frequently broken, and hitherto has been considered the most difficult of all fractures to manage. To the ingenuity, however, of the late Dr. J. Hartshorne, of this city, the world is indebted for an apparatus which does away the greatest impediments that have been found to exist in treating it, so as to leave a straight limb, without lameness or deformity. Nor is it the least of its merits, that any man of common sense can apply it nearly as well as a surgeon.

It consists of two splints made of half or threequarter inch well-seasoned stuff, from eight to ten inches wide, one of which should reach from a little above the hip to fifteen or sixteen inches beyond the foot, while the other extends the same length from the groin. The upper end of the inner splint is hollowed out and well padded or stuffed.

Their lower ends are held together by a crosspiece, having two tenons, which enter two vertical mortices, one in each splint, and secured there by pins. In the centre of this cross-piece (which should be very solid) is a female screw. İmmediately above the vertical mortices are two horizontal ones of considerable length, in which slide the tenons of a second cross-piece, to the upper side of which is fastened a foot-block, shaped like the sole of a shoe, while in the other is a round hole for the reception of the head of the male screw, which passes through the female one just noticed. On the top of this cross-piece, to which the foot-block is attached, are two pins, which fall into grooves at the head of the screw, thereby firmly connecting them. The foot-block, as before observed, is shaped liks the sole of a shoe. Near the toe is a slit, through which passes a strap and buckle. Near the heel are a couple of straps, with two rings, arranged precisely like those of a skate, of which, in fact, the whole foot-block is an exact resemblance. A long male screw, of wood or other material, completes the apparatus.

To apply it, put a slipper on the foot of the broken limb, and lay the apparatus over the leg.

By turning the screw the foot-block will be forced up to the foot in the slipper, which is to be firmly strapped to it, as boys fasten their skates. By turning the screw the contrary way, the padded extremity of the inner splint presses against the groin, and the foot is gradually drawn down, until the broken limb becomes of its natural length and appearance, when any projection or little inequality that may remain can be felt and reduced by a gentle pressure of the hand.

The great advantages of this apparatus, I again repeat, are the ease with which it is applied, and the certainty with which it acts. The foot once secured to the block, in a way that every schoolboy understands, nothing more is required than to turn the screw until the broken limb is found to be of the same length as the sound one. It is right to observe that this should not be effected at once, it being better to turn the screw a little every day, until the limb is sufficiently extended.

As this apparatus may not always be at hand, it is proper to mention the next best plan of treating the accident. It is found in the splints of Desault, improved by Dr. Physick, oonsisting of four pieces. The first has a crutch head, and extends from the arm-pit to six or eight inches beyond the foot. A little below the crutch are two holes, and near the lower end, on the inside, is a block, below which there is also a hole. The second reaches from the groin, the same length with the first, being about three inches wide above and two below. Two pieces of stout pasteboard, as many handkerchiefs or bands of muslin, with some tow or raw cotton, and a few pieces of tape, form the catalogue of the apparatus.

It is applied as follows. Four or five pieces of tape are to be laid across the bed, at equal distances from each other. Over the upper two is placed one of the short pasteboard splints, well covered with tow. The patient is now to be carefully and gently placed on his back, so that his thigh may rest on the splint. One of the handkerchiefs, or a strong soft band, is to be passed between the testicle and thigh of the affected side, and its ends held by an assistant standing near the head of the bed. The second handkerchief is to be passed round the ankle, crossed on the instep, and tied under the sole of the foot. Instead of this, a number of long strips of adhesive plaster, two inches wide, may be applied to the ankle and up the leg, and tied together below the foot.

By steadily pulling these two handkerchiefs, the limb is to be extended, while, with the hand, the broken bones are replaced in their natural position. The long splint is now to be placed by the side of the patient, the crutch in the arm-pit (which is defended with tow), while the short one is laid along the inside of the thigh and leg. The ends of the first handkerchief, being passed through the upper holes, are to be drawn tight and secured by a knot, while the ends of the second one pass over the block before mentioned, to be fastened in like manner at the lower one.

All that remains is the short pasteboard splint, which, being well covered with tow, is to be laid on the top of the thigh. The tapes being tied so as to keep the four splints together, completes the operation.

Tow or raw cotton is to be everywhere interposed between the splints and the limb, and a large handful of it placed in the groin, to prevent irritation from the upper or counter extending band. It is necessary to be careful, while tying the two handkerchiefs, that they are not relaxed, so that if the operation is properly performed, the two limbs will be nearly of an equal length.

The superior advantages of Hartshorne's apparatus over this, as well as all others, must be evident to every one acquainted with the difficulty of keeping up that constant extension which is so absolutely necessary to avoid deformity and lameness, and which is so completely effected by the screw. Next to that, however, stands the one just described, which can be made by any carpenter in a few minutes, and which, if carefully applied, will be found to answer extremely well.

While waiting for apparatus, the thigh may be kept extended by attaching a weight of a few pounds to the extending band below the foot, and suspending it beyond the foot of the bed.

Fractured thighs and legs generally reunite in six or eight weeks; in old men, however, they re quire three or four months.

In cases of fracture of the thigh or leg, the patient should always, if possible, be laid on a mattress, supported by boards instead of the sacking, which, from its elasticity and the yielding of the cords, is apt to derange the position of the moment of the accident, a difficulty in standing, limb.

Fractures of the Knee-pan.

This accident is easily ascertained on inspection.

It may be broken in any direction, but is most generally so across or transversely. It is reduced by bringing the fragments together, and keeping them in that position by a long bandage passed carefully round the leg, from the ankle to the knee, then pressing the upper fragment down so as to meet its fellow (the leg being extended), and placing a thick compress of linen above it, over which the bandage is to be continued. by the swelling, and by the grating noise on moving the heel. To reduce, take a long bandage, lay the end of it on the top of the foot, carry it over the toes under the sole, and then by several turns secure it in that position.

The foot being extended as much as possible, carry the bandage along the back of the leg above the knee, where it is to be secured by several turns, and then brought down on the front of the leg, to which it is secured by circular turns. In this way the broken pieces will be kept in contact, and in the course of a month or six weeks will be Fractures of the foot, toes, etc., are to be treated like those of the hand and fingers.

The extended limb is now to be laid on a broad | united. splint, extending from the buttock to the heel, thickly covered with tow to fill up the inequalities of the leg. For additional security, two strips of muslin may be nailed to the middle of the splint, and one on each side, and passed above the joint, the one below, the other above, so as to form a figure of eight. In twenty or thirty days the limb should be moved a little to prevent stiffness.

But it usually requires two or three months for perfect union of this bone.

If the fracture is through its length, bring the parts together, place a compress on each side, and keep them together with a bandage, leaving the limb extended and at rest. Any inflammation in this or other fracture is to be combated by bleeding, low diet, etc., etc. Fractures of the Leg.

From the thinness of the parts covering the principal bone of the leg, it is easy to ascertain if it be broken obliquely. If, however, the fracture be directly across, no displacement will occur, but the pain, swelling, and the grating sensation will sufficiently decide the nature of the accident.

If the fracture is oblique, let two assistants extend the limb, while the broken parts are placed by the hand in their natural position. Two splints, that reach from a little above the knee to nine or ten inches below the foot, having near the upper end of each four holes, and a vertical mortice near the lower end, into which is fitted a cross-piece, are now to be applied as follows:-Lay two pieces of tape about a foot long on each side of the leg, just below the knee-joint, and secure them there by several turns of a bandage; pass a silk handkerchief round the ankle, cross it on the instep, and tie it under the sole of the foot. The two splints are now placed one on each side of the leg, the four ends of the pieces of tape passed through the four holes and firmly tied, and the cross-piece placed in the mortice. By tying the ends of the handkerchief to this cross-piece the business is finished.

If the fracture is across, and no displacement Of Dislocations.

The signs by which a dislocation may be known have been already mentioned. It is well to recollect that the sooner the attempt is made to reduce it the easier it will be done. The strength of one man, properly applied, at the moment of the accident, will often succeed in restoring the head of a bone to its place, which in a few days would have required the combined efforts of men and pulleys.

If after several trials with the best apparatus that can be mustered, you find you cannot succeed, make the patient drink strong solution of tartar emetic until he is very sick. In this way, owing to the relaxed state of the muscles, a very slight force will often be sufficient, where a very great one has been previously used without effect.

If any objections are made to this proceeding, or if the patient will not consent to it, having your apparatus (which is presently to be mentioned) all ready, make him stand up, and bleed him in that position until he faints; the moment ; the moment this happens, apply your extending and counterextending forces. Another important rule is to vary the direction of the extending force. A slight pull in one way will often effect what has been in vain attempted by great force in another.

Dislocation of the Lower Jaw.

This accident, which is occasioned by blows or yawning, is known by an inability to shut the mouth, and the projection of the chin. To reduce it, seat the patient in a chair, with his head supported by the breast of an assistant, who stands behind him. Your thumbs being covered with leather, are then to be pushed between the jaws, as far back as possible, while with the fingers outside you grasp the bone, which is to be pressed downwards at the same time that the chin is raised. If this is properly done, the bone will be found moving, when the chin is to be pushed backwards and the thumbs slipped between the exists, apply two splints of stout pasteboard, jaws and the cheeks. If this is not done, they reaching from the heel to the knee, and well covered with tow, one on each side of the leg, securing them by a bandage passing round the limb, and outside the splints. Instead of splints, however, a fracture-box is often used, made by fastening, with hinges, to a bottom-piece rather longer than the leg, two side-pieces about six inches high, and reaching above the knee. The leg may rest in this on a pillow. A footboard fastened to the bottom-piece may serve to fix the foot by the aid of a bandage.

In cases of oblique fracture of the leg close to the knee, Hartshorne's apparatus for fractured thighs may be applied, as already directed.

Fractures of the Bones of the Foot.

The bone of the heel is sometimes, though Brely, broken. It is known by a crack at the will be bitten by the sudden snap of the teeth as they come together. The jaws should be kept closed by a bandage for a few days, and the patient live on soup. Dislocation of the Collar-bone.

This bone is rarely dislocated. Should it occur, apply the bandages, etc., directed for a fracture of the same part.

Dislocation of the Shoulder.

Dislocations of the shoulder are the most common of all the accidents of the kind. It is very easily known by the deformity of the joint, and the head of the bone being found in some unnatural position. To reduce it, lay the patient on the ground, place your heel in his arm-pit, and steadily and forcibly extend the arm by grasping it at the wrist. The same thing may be tried in various