MOLDED SPLINTS.—Wire gauze is a convenient material to mold over a limb for a light splint. Leather and felt are similarly made use of. After being thor oughly soaked in water they are molded and bandaged to the limb and allowed to dry in place. Gutta-percha previ ously heated and molded has also been used. All of these have, however, been supplanted by plaster-of-Paris and sili cate-of-soda (artificial glass) splints. To make a plaster splint a number of thick nesses of gauze, muslin, or blanketing of the desired dimensions are immersed in a freshly-made solution of plaster-of Paris of the consistency of thick cream (a small amount of common salt or, better, sulphate of zinc added to the fluid makes it harden quicker) until the material is thoroughly impregnated. It is then squeezed out and applied to the limb which has been coated with vaselin in the meanwhile. If the splint must turn a sharp angle (elbow or heel) it can be fitted by notching its edges and over lapping the edges of the notches. then bandaged in place until it dries, after which it may be retained by a few turns of the bandage or adhesive plaster. Such splints are not very strong (but may be strengthened by incorporating in them rods of iron or wood), but they offer the great advantage of allowing the fracture to be inspected with the mini mum of disturbance. The plaster band age is most conveniently made by roll ing a gauze bandage loosely, filling it at the same time with dry plaster. The bandage is allowed to soak for a few min utes in a hot, weak solution of sulphate of zinc and is then applied to the limb previously incased in a thin layer of cotton or a stocking. The bandage is best applied as an "anterior reverse," without actually reversing, however. Dextrin, starch, glue, and silicate of soda (the last being the best) are similarly used. The most convenient way to apply such bandages is to rub the solution into each layer of the bandage after it is ap plied. Silieate-of-soda bandage is more
elegant than the plaster-of-Paris, but it is not so strong nor does it "set" so quickly. Such bandages may be fenes trated by cutting out a piece of the plaster after it has hardened, or inter rupted by incorporating in the two sec tions of the splint the ends of two or three —n-- shaped and straight bands of iron. Such interruptions are likely to weaken the splint. To cut a plaster splint for fenestration or removal the best instrument is a short, sharp, stout bladed knife, whose efficacy is enhanced by wetting the line of section with dilute hydrochloric acid. To prevent shorten ing the splint must have points of coun ter-pressure at opposite ends of the fract ured bone. The edges of fenestration may be protected by rubber tissue or varnish.
The toes and fingers should always be left exposed, and they should be fre quently inspected during the first few days in order that the splint may be re moved in case it interferes with the cir culation. If the patient is then to pass from the constant observation of the sur geon he should not be allowed to go until he has been watched for twenty-four hours with his limb as dependent as it will be during the convalescence. Then he and his friends must be carefully in structed as to the dangers of which cold ness, swelling, and discoloration of the digits are the forerunners, and warned to report before gangrene has set in. Sub sequently it will be well to inspect the splint once a week in order to be sure that the limb has not shrunk enough to allow motion at the seat of fracture. A good routine rule is that the splint shall be reapplied every ten days.