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Fractures Of Bone

fracture, fragments, physician and displacement

BONE, FRACTURES OF.- -Complete breaking of a bone is designated as frac !ure. If the break affects only a part of a bone section, it is called an infraction : if only cracks and clefts are caused, it is called a Lorr fissure, or at times a green slick iraclure : if only a small part of the bone is detached, it is a splinter. In case the skin over the point of the fracture is also torn, the fracture is de4gitated as open, complicated, or emu timild (see Plate XVI. and Figs. 93, 94, 95).

The surest sign of a fracture is the displacement of the separated parts of the bone, which sometimes can be recognised even externally in that one or both fragments project distinctly under the skin. Greater certainty is afforded by palpation of the shin over the fracture by the physician, so long as no material swelling has occurred. Every touch and movement which may cause a displacement of the fragments of the bone will give rise to great pain. Regularly, owing to simultaneous contusion of the soft parts, there is a more or less profuse loss of blood which, with the direct injury, causes great swelling. The fractured limb should not he used. Healing takes place by the formation of new hone at the fractured ends. This bone-mass (callus) is at first soft, but later it becomes N..ery hard and firmly unites the fragments of the bone (see Fig. (68), If the fragments remain in the correct position (luring the time required for the healing, the fracture heals straight ; otherwise, more or less crooked, as a rule causing a shortening of the limb (see Fig. 69).

If it is not possible in cases of fracture to obtain the aid of a physician immediately, emergency splints should he applied ; the helper must, how ever, make it his only object to allay the pains of the injured, and must make no allempt to adjust the displacement of the bones. The bones most exposed to fracture are the long, tubular ones (upper arm, forearm, thigh, and lower leg). After having removed the clothes covering the seat of the fracture, which is best done by ripping the scams, the limb should be wrapped in wadding or soft cloths ; over this should he placed splints made from thin pieces of wood, box-covers, cardboard, tin, bark, or any other material that may be at hand (see Figs. 96, 97, 98), and these splints should he tied: with strips of gauze, linen, rags, shirt strips, suspenders, etc. I f the fra6ture is a compound one, great care must be taken to avoid infection. An absolutely clean cloth, put in boiling water for ten to fifteen minutes and then wrung out, may be applied tightly until the physician arrives.

Injuries of hones by gunshot wounds and by machinery are shown on Plate XVI,, Figs. 3, 4, 5.