RAHTICULAIL FRACTURES.
We shall say a few words on the most common and important kinds of fracture.
Fracture of the lower jaw may be detect. ed by introducing a finger into the mouth and pressing on the front portion of the bone, while the fingers of the other hand are applied on the outside to the back of the bone. Alternate pressure in these situations occasions a very distinguishable crepitus. When the broken ends are adapted to each other, some wetted paste board is to be applied along the outer surface and base of the bone ; and over this a bandage, with four tails, should be placed. The centre of this bandage is applied to the chin, the two posterior tails tied together at the top of the head, and the other two more posteriorly. The wet pasteboard adapts itself to the figure of the part, and constitutes, when dry, a splint exactly accommodated to the furm of the jaw. All motion of the broken bone should be avoided : hence talking, chew ing, &c. are improper; hence, too, the food should be soft, and introduced by a spoon.
The feeeture of the clavicle is attended with a displacement of the bone ; its sca pular portion being drawn downwards and forwards. In order to restore it, let the shoulder be drawn .backwards, and the arm raised ; then the surgeon should place the fracture in as even a position as he can, cover it with a piece of soap ter, and keep the shoulder back by means of the figure of eight bandage ; the fore arm and elbow being well supported by a string. A leather apparatus, lacing be hind, and having straps to pass in front of the shoulders, similar to the instruments used for girls with the view of keeping the shoulders back, is a more effectual mode of accomplishing the object.
It is often difficult to detect fracture of the ribs. By placing the fingers where pain is felt, or where the blow was receiv. ed, a crepitus can be distinguished in many cases, on making the patient cough ; yet, if the matter be doubtful, the safest plan is to treat the patient as if his ribs were broken. It will be readily seen how emphysema, extravasation of blood, &c. may occur, when the bone is displaced in wardly. Our object is to keep the broken ends motionless. Hence, after a piece of soap plaster has been applied externally on the situation of the fracture, a broad roller should be put firmly round the chest, or we may apply an apparatus made ex pressly for the purpose, consisting of a broad girth,•ith three or four buckles and straps, which may be tightened at plea sure. Bleeding is proper, unless particu lar circumstances contraindicate it.
In fractures of the os brachii, after re storing the limb to its natural figure, and putting on a piece of soap plaster, apply a splint, lined with a pad of soft materials, from the acromion tothe external condyle, and another from the margin of the axilla to the internal condyle. Some add two
others, one before and one behind. They must all be carefully fastened with tapes, and the fore-arm and hand should he well supported by a sling. There is always a distinguishable crepitus in fractures of the After a piece of soap plaster has been applied, two splints must beemploy ed ; one is to be placed along the inside, ,and the other along the outside, of the fore arm. The limb is to he in the mid state, between pronation and supination and the inner splint should reach far enough into the hand to support it, and prevent it from falling into the prone state.
In fractures of the okcranon the elbow must be placed straight, to approximate as much as possible the broken ends, and the limb must be continued in that posi tion until the patient has recovered.
When the os fensorio is broken, there is severe local pain, an incapacity to move the limb, a distinguishable crepitus on mo tion, and deformity of the part from re traction of the lower portion. The lat ter appearance will occur more readily, in proportion as the fracture is more ob lique ; and it arises entirely from the ac tion of the muscles which are fixed in the bone below the fracture, together with the flexors of the knee. Besides the short ening of the limb, produced by the re traction of the lower portion of the frac tured bone, there is another deformity, arising from its being rotated outwards, an effect produced by most of the large muscles of the thigh. The higher the frac ture, the more difficult is it to prevent displacement. When the neck of the thigh bone is broken, there is severe pain in the groin, much aggravated by motion of the part. The extremity is shortened, the limb turned out, and the trochanter higher than usual towards the pelvis. Yet the limb may be drawn down to its natu ral length, in doing which a crepitus is sometimes perceived. In order 'to relax as much as possible the muscles which tend to displace the broken bone, a bent position of the thigh and leg seas recom mended by Mr. Pott. He recommended that the patient should lie on the side of the fracture, with the thigh bent on the pelvis, and the knee half bent. A broad splint, well padded, should be placed un der the thigh, from above the trochanter to below the knee, and another should extend from the groin below the knee on the opposite surface. Narrower splints should occupy the intervals between those on the inside and outside of the thigh. The splints should be fastened as firmly as they can he borne, by means of leathern straps. A patient with a broken os fenioris should by no means be placed on a soft bed, as the trunk of the body depresses it into a hollow, and by slid ing downwards increases the displace ment.