SPRAINS.
When surgical aid is immediately available the best procedure is to apply a rubber bandage with a moderate degree of pressure commencing at the distal end of the limb in which the sprained joint is located and extending well above the articulation. The bandaged joint may then be placed underneath a cold-water tap and held there as long as the patient can tolerate the cold application.
Another immediate treatment is to surround the limb with cotton-wool and firmly bandage it over this with an ordinary woven or elastic bandage, after which the extremity is to be elevated in order to minimise any tendency to venous congestion.
Whichever method is employed, it must be supplemented by rest for a few days, but should pain and tension supervene, the swollen sprain must he treated as if the case had come under notice some hours after the accident. The bandage should be removed, and cold applications, as Ice, Leiter's tubes or evaporating lotions applied in order to check further effusion or hmmorrhage, the entire limb being steadied on a splint or rendered immobile by the use of sand-bags.
Swelling following injury, and occurring within 24 hours with distension of the joint, may be taken as evidence of hmmorrhage into it, and is a clear indication for prolongation of the application of cold and pressure. Seldom will it be necessary to tap the joint; this should always be avoided as long as possible.
When the pain is severe, and there are no indications of hcemarthrosis, hot applications or fomentations are soothing. A good routine is to surround the joint with lint soaked in the following lotion, and apply oiled silk under a bandage: 13. . Liquor. Pluinbi Fort. 3iv.
Acid. Acct. Dil.
Spt. Vint Rect.
Aqwe Destill. ad xvj. Misce.
'Ellis application will act like a poultice when covered with an impervious dressing; if the latter is dispensed with it will serve as an evaporating lotion. Laudanum may be substituted for the spirit.
Formerly a sprained joint was subjected to prolonged rest and fixation with the view of favouring union of lacerated fibroid tissue; the resulting stiffness, rheumatism and rheumatoid arthritis were attributed to the effect of the sprain, and not to the irrational treatment. Now massage and passive or active joint movements are started immediately after the accident, and the patient is directed to commence the use of his limb within a few days. This is the usual example of the swing of the pen dulum; the safe plan is to strike a mean and abstain from massage till the danger of haemorrhage and synovitis has passed away, but massage should be practised in all cases before the end of a week. As the patient is permitted to move the joint, the elastic bandage should be left in situ or strapping applied when there is reason to believe that a ligament has been torn.
Douching alternately with hot and cold water should be combined with the massage, and where pain continues a local hot-air or radiant-heat bath should he employed.
Sir Robert Jones has pointed out that the:object of treatment in sprain of a joint is to obtain a reformation of a sound ligament. He therefore advocates such application of strapping as will prevent stretching of the ligament during the process of repair. He allows only such move ments of the joint as will entail no strain upon the injured band. In the case of the ankle, for example, he places two straps crossing over the seat of the injury and thickens the heel and sole of the hoot by 1- inch under:the corresponding side of the limb.