A practical treatise on fractures and dislocations / by Frank Hastings Hamilton.
- Frank Hastings Hamilton
- Date:
- 1891
Licence: Public Domain Mark
Credit: A practical treatise on fractures and dislocations / by Frank Hastings Hamilton. Source: Wellcome Collection.
Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.
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![Fracture of the Neck of the Femur.—The most important fact to be borne in mind in the care of this injury is this, the fracture may be partial or im- pacted. If it is partial or impacted it is in the best possible condition for rapid union. But by rude handling, as in lifting the patient, the partial or impacted fracture may be made complete, and thus in a moment irreparable injury is done to the patient. It is well to assume, in all cases, that the fracture is not com- plete, for if that fact is prominently in the mind of the surgeon who prepares his patient for transportation, he will exercise that degree of care which is essential in all cases. A well-padded, long splint should be applied, extending from the foot to the axilla, and be retained by a broad towel around the hips and stout bandages at other points. This dressing should be adjusted without removal of the clothes, and with as little movement of the limb as possible, except that the foot should be placed in its proper position if it is too much everted or inverted. Fracture of the Shaft of the Femur.—In this fracture there is usually much displacement at first. A long splint should be applied externally from the foot to the axilla, as in the preceding case, and a short splint internally from the foot to the groin. Before they are fastened to the limb, the leg should be gently but firmly extended and the eversion of the foot corrected. Plaster-of- Paris, if at hand, may be used with great advantage in the form of a splint. This can be made of two layers of woollen blanketing, cut of the length of the thigh and sufficiently wide to surround the limb. The blanket is soaked in the dissolved plaster and quickly applied, and retained by bandages. In a few minutes it will be firm. This dressing is to be preferred if the patient is to be transported a long distance. Fractures Near or Into the Knee-joint.—The same dressings as in frac- tures of the shaft of the femur are generally best adapted to secure the limb from further injury when the fracture is near or into the joint. It may happen that the slightly flexed position is most comfortable. In that case the knee may be bent over a firm pillow or other support. Fractures of the Patella.—The important point to be made in this fracture is that the leg must not be flexed, but rather must be maintained in a state of extreme extension. For this purpose a firm splint must be applied on the pos- terior part of the limb, extending from the middle of the thigh to the middle of the leg, and be firmly retained by a bandage or broad tapes. Fractures of the Leg.—The plaster-of-Paris splint above described makes the best dressing for these cases and is most readily applied. The blanket must be cut in such manner as to form a good covering of the foot. Another dress- ing, which may be readily extemporized, is a thin j>illow, of hair, straw, or even feathers. The leg is placed in the middle and the sides of the pillows are folded up over it; then several tapes are firmly tied at different points around the whole. The same dressings are most useful when the fracture involves the j^arts entering into the ankle-joint.] § 2. General Treatment of Fractures. Nearly all fractures present three principal indications of treatment, namely: to restore the fragments to place as completely as possible; to maintain them in place; and to prevent or to control inflammation, spasms, and other accidents. It ought to be regarded as a rule, liable only to rare exceptions, that broken bones should be restored to place, or to the position in which we hope to maintain them, as soon as possible after the occurrence of the accident. If the patient is seen within the first few hours, or before much swelling has taken place, we scarcely know the circumstances which would warrant an omission to adjust the fragments either end to end or side by side, as the one or the other might be found to be practicable. We have before sufficiently explained the general impossibility of again restoring to place, end to end, and fibre to fibre, fragments which have been](https://iiif.wellcomecollection.org/image/b21056699_0053.jp2/full/800%2C/0/default.jpg)
