FRACTURE, a broken bone. Inasmuch as the greatest variety in the nature, extent and complications may be observed, a certain classi fication of fractures is desirable. Modern sur geons classify them into about seven different categories or grpups. Group 1. According to the degree of the fracture they are complete or incomplete or partial. Partial fractures are known as green stick fractures or they may consist of simple bony depressions, as in the bones of the skull, for instance, or simply by crushing of a bone or the separation of a splinter or of an epiphysis at the end of the bones. Group 2. Fractures are described ac cording to the direction taken in the break, as longitudinal, transverse, oblique, crushed or comminuted, impacted fractures, where a part of the bone is jammed into another part. Group 3. The fracture may be classified in terms of its location — shaft, head, upper or lower third, or it may be named in terms of the contiguous structure. Supracondylar, Submal leolar, etc. Group 4. In term of the cause of the fracture. Traumatic, as from a fall, blow or other injury. As in warfare from bullet wounds, smashing from explosions, etc. Mus cular violence may cause a fracture at times. In certain pathological states of the nervous system, such as in syphilis (tabes) or in cer tain chronic diseases of the spinal cord (sy ringomyelia, chronic _poliomyelitis, etc.), spon taneous fractures are known to occur. Group 5. Fractures may be open, when the skin is cut, or they may be dosed when there is no external wound. These fractures were usually termed compound or simple fractures respectively, but the terms open and closed are really more descriptive. Group 6. Fractures are still fur ther divided into complicated and uncompli cated. Group 7. Single or mutiple fractures according to the number of fragments.
Thus a fracture may come to be described in a number of terms. A tabetic who may happen to slip while walking may thus have a trophic, traumatic fracture from the fall or from the muscular exertion to right himself. This frac ture might he open or closed, single or multiple, comminuted, complicated, transverse and com plete. The most diverse and frightful bone injuries arise from the shrapnel wounds of war fare. Inasmuch as there are so many techni calities connected with fractures they call for the most technical management. In a lay art icle such as this only the simpler type of de scription will be given, dealing only with such fractures which may call for first aid. A frac ture may usually be recognized by the pres ence of great pain, swelling and loss of func tion of the part following an accident or injury such as usually may result in breaking a bone. By careful handling of the affected parts, or by the patient himself making movements of the parts, a sort of grating of the broken ends can be felt. This rubbing or crepitus is a valuable sign and when present always indi cates the break in the bony structures. Thus pain, swelling or deformity and crepitus are the chief signs of a fracture. A fracture may
result, however, without there being evident crepitus. Therefore in all doubtful cases and, in fact in all suspected cases, an X-ray examina tion should be made a routine procedure. By the incoming of the X-ray technique, the knowledge of fractures has increased enor mously. First aid of closed, uncomplicated fractures consists in giving some support to the part until the physician can be summoned. When the wound is open, however, first aid may be of great service in limiting the possibilities of infection. Open fractures are complicated by the cutting of the skin or of the muscular parts. If there is much bleeding, this must be controlled by a tight compress. This can con sist of a folded towel which has been placed in boiling water a few moments, or if time is an element, a clean towel can be applied directly to the wound. Blood is one of the best anti septics until the doctor comes, and it is better to let the blood be on a complicated open fracture than to attempt poor minor surgery by washing. Complicated open fractures should be even more securely supported and prevented from cutting the tissues more during removal by careful bandages and supports.
The individual symptoms are subject to con siderable variation so a short description may be of service in further aiding the first aid diagnosis. The pain is apt to be immediate. It is apt to be quite sharp and severe and acute and is distinctly aggravated by the movement of the parts involved. Unless the part is ban daged there is a tendency on the part of the patient to involuntarily move the fragments which causes a certain amount of movement, hence the continuance of the pain. While the pain is usually closely localized, it may follow the course of a nerve trunk which may have been injured by the fragments. There is usu ally marked local tenderness. A widely-used surgical rule is as follows: When pressure is put on the sides of a bone at some distance from the point of localized tenderness, and it gives rise to pain at the site of tenderness, there usually is a broken bone. Such pressure may be lateral or along the long axis of the bone. Broken bones usually show a deformity of the parts. Careful looking at the affected regions is enough to make a diagnosis in cer tain localities; thus there is the characteristic silver fork appearance of a broken wrist, and other localities have their characteristic defor mities. Crepitation and X-ray examination have been discussed sufficiently. With the widespread facility for X-ray examinations there is no excuse for faulty diagnosis and treatment. Every fracture should be X-rayed. No doctor should feel satisfied without the valu able information which this can give, and thus be of use to the patient. Every patient should insist upon it. Consult Keen,
Stimson, Fractures' ; Bryant,
; Sted man,