In impacted fracture unnatural movement and grating will be absent, and deformity and shortening will be the chief signs.
Distinction between Fracture, Dislocation, and Bruise.—It has been said that in dislocation the movement is diminished instead of in creased, the dislocated bone being unnaturally fixed; and there is no crepitation. In a bruise there will be pain, swelling, and loss of function as in fracture, and the swelling may be so great as to prevent a proper examination. In such a case the limb should be kept quiet, supported, and hot cloths applied till the swelling snimidea Then it will be found that if there be merely a bruise and no fracture, there will be no un natural motion and no crepitation.
Treatment.— Temporary Treatment. It often happens that a person receives a fracture and has to be carried some distance before being regularly attended to. In such a case it is extremely desirable that the broken limb should be so fixed that dangling is prevented and no movement permitted. If this is not done there is great risk that the ends of the broken bone, moving about freely among the muscles, nerves, and blood-vessels, may do damage much more serious than the original break, and may even force their way through the tissues, causing a wound, and so converting a simple into a com pound fracture. To prevent this is easy. The limb should be rendered immovable by placing on each side something rigid. A walking-stick or umbrella, in the absence of anything else, would do. Bark stripped from a tree, pieces of wood torn from a paling, and so on, would, for the time, equally answer time purpose. What ever is employed should be secured by straps, which may be obtained from handkerchiefs, or strips of cloth torn from some article of clothing. Then, if the thigh or leg has been broken, after it has been rendered immovable in this way the person should be placed on a stretcher, or whatever can be got in its place, in such a way that the whole of the injured limb is sup ported. If, for instance, the foot and part of the leg were left projecting beyond the stretcher, they would act as forces dragging the broken parts- asunder, and every step of the carriers would communicate great pain to the sufferer. In order further to support the broken leg it might be placed alongside the sound one and strapped to it.
Systematic Treatment.—There are two main conditions to be fulfilled in the treatment of fracture: the first is to restore the bone to its natural position, and the second is to retain it in that position till it can have time to heal. (1) Restoring of the bone to its natural position, or the reduction of the fracture, is best effected by considering what are the forces that tend to displace the Lone. The forces are particularly muscular, and it is, therefore, necessary to grasp the limb--that part of it which carries the lower fragment—and pull it firmly but steadily in a direction opposed to the muscles that displace and in the axis of the limb. This is called extension ; and, along with it, what is termed counter-extension must be employed, which consists in fixing the upper fragment so that it may not be pulled on also, and may afford a firm position from which the lower fragment may be extended. As soon as sufficient exten
sion has been practised the ends of the bone must be brought together, so as to lit as accu rately as possible. It is done by keeping the upper fragment fixed, and bringing the lower one into the same straight line, so that the proper relations between the two may be re stored. This is coaptation or setting. It is some times rendered difficult by splinters of bone pre venting the proper adjustment of the two ends, and in all cases is not to be accomplished by force, but only by careful working by the hand. Fracture differs from dislocation in the ease with which the bone can be returned to its proper place in fracture, and its difficulty in dislocation. But there is another difference, that, namely, after a fractured bone has been reduced, as soon as the extending force has been withdrawn, the displacement tends to return; and in dislocation, though the reduction is diffi cult, it is permanent. Therefore in fracture there is the necessity of some means of retaining the bone in position, once the reduction has been effected. This is accomplished by me chanical means—by the use of splints made of wood, pasteboard, or other stiff material, to which the limb is strapped. The splints ought to pass from the joint immediately above the fracture to the joint immediately below, and are usually placed on each side of the limb. The splints are fitted more accurately by the use of pads, and are secured by bandages. So well should they fit and so tightly ought they to be secured, that not the slightest movement can be effected between the opposed ends of the broken bone. Such movement, if permitted, is one of the commonest causes of non-union of fracture. At the same time care must be taken that the bandages do not unduly or irregularly compress the soft parts of the limb or interfere with the circulation of blood in it. The person ought to be laid upon a firm mattress, soft beds being hurtful, and the limb ought to be equally supported on the bed, so that no undue weight is on any part of it. From time to time an ex amination must be made to see that the broken parts retain their position ; and this ought to be done without disturbing the splints or their fastening's. The splints ought, for this purpose, to be kept applied to the limb by straps inde pendently of bandages, so that if the bandages require to be removed the fixture of the splints is not interfered bandaging, &c., see p. 558, Vol. II.) .; As the result of fracture there may be some degree of fever and inflammation. To combat these the patient should first of all get some opening medicine, of which salts, seidlitz, &c., in fact saline medicines, are the best. To the part, if inflamed, cold water cloths may be ap plied ; and to allay pain one-grain doses of opium may be administered at night, but only to an adult.