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Fractures of both Bones of the Leg.Fractures of both bones of the leg may be divided for conven ience into two classes : simple and compound ; that is, those which are not, and those which are accompanied with wounds of the flesh communicating with the break in the bone. This distinction is an item of much consequence in the treatment. The most frequent variety of fractures involving both bones of the leg, is that in which the tibia is broken in its lower part and the fibula at the upper part near the knee. In every case in which the tibia is found to be fractured near the ankle, a careful examination of the fibula at its upper part should be made ; for in many cases the fracture of the fibula in this part is overlooked by inexperienced persons. Treatment.- The treatment of simple fractures - that is, those in which there is no wound of the skin - consists in restoring the limb to its natural length and contour, and in holding the bones in position by means of a dressing. There is rarely any difficulty in setting the bones ; the patient is placed upon his back, and by gently pulling upon the foot, we can usually restore the broken fragments to their natural position. It is, however, by no means so simple a matter to keep the fragments in position ; for the powerful muscles attached to the bones of the leg are constantly tending to displace the broken ends, as well as to shorten the leg. The dressing must, therefore, be applied not only with great care, but also with an accurate knowledge of the requirements of the case. There are numerous dressings employed in the treatment of fractures of the leg ; each of these has certain advantages in certain cases. One frequently applied is the plaster of Paris bandage; leather, starch bandage, and the fracture-box are frequently used. Probably the most generally useful of all dressings for fractures of the leg is that made of plaster of Paris. This can often be applied immediately after the injury, though it is better to wait until the swelling, which almost invariably occurs, has been reduced by hot-water dressings. If the bandage be applied before the swelling has begun - that is, immediately after the receipt of the injury - the pressure of the dressing will probably cause serious injury and perhaps mortification of the tissues. Indeed, in every case in which a plaster of Paris dressing is applied to the leg, the circulation of the limb should be carefully watched ; this can be observed by inspecting the condition of the toes and of the foot; whenever this part of the limb becomes cold, blue and numb, we may know that the circulation is impeded and that the dressing is too tight. In such a case the bandage should be at once removed and re-applied more loosely ; the failure to do this may result in mortification (gangrene) of the flesh. The plaster of Paris dressing may be applied to the leg in the following way : Some loose cloth, such as an old sheet, should be cut so as to make seven or eight bandages, each about nine feet long and three inches wide. These bandages, unrolled, are thickly dusted over with plaster of Paris, which is rubbed into the meshes of th'e cloth. The bandages are then rolled up and laid aside for subsequent use. The limb is then enveloped with cotton batting, from the toes to the lower part of the thigh. This may be held in place by a few coarse stitches. The bandages containing the dry plaster of Paris are then placed for about three minutes in lukewarm water. One of these is then applied to the limb, beginning with the foot, just above the toes. It is wound smoothly over the cotton batting as far as the knee. A second bandage is then applied over the first, a fresh roll being placed in the water to soak during the application of the second to the limb. This is done so that the bandages shall not lie in the water more than three or four minutes ; for if they do remain in a longer time the plaster becomes brittle and " crumbly," so that it will not set firmly enough to make a stiff dressing. Three or four thicknesses should be applied to the limb. After the last bandage is applied, a little plaster mixed with water, so as to have the consistency of cream, should be laid on with the hand and plastered smoothly over the limb. Such a dressing becomes hard in half or three-quarters of an hour, though it may not dry entirely for several hours. During the first half-hour or hour - that is, until the plaster becomes sufficiently hard to retain the limb in position - the leg should be held by an assistant. This is a very important part of the process, since if it be carelessly done, the fragments may become displaced before the plaster becomes hard, as a result of which the limb may heal with some deformity. The assistant who holds the limb during the hard ening of the plaster should, therefore, be carefully instructed to pull gently upon the foot, so as to preserve the natural length of the limb, while, at the same time, the calf is supported so that the broken ends shall remain on the same level. This is a somewhat tedious task, which should be entrusted only to a conscientious assistant. After the plaster has become thoroughly hardened - say after ten or twelve hours - the bandage may be cut open by passing a pair of strong shears along the front of the leg. The edges of the plaster may then be turned upward a little, so that they shall not scratch the skin ; and some cotton should be tucked under these edges to protect the limb. After a few days it will usually be found that the limb has shrunken somewhat, so that the bandage seems a little large ; in this case it may be tightened by applying an ordinary muslin bandage around it from the foot upward, or by simply tying two strips, one at the ankle and the other just below the knee. In every case in which plaster of Paris dressings are applied, it should not be forgotten that damage can be inflicted by impairment of the circulation ; the caution already given regarding the condition of the toes must be observed. Another form of plaster splint is the so-called " Bavarian " dressing, which was used extensively in the Franco-Prussian war. This is made out of some soft thick cloth, such as flannel or cheese cloth ; two pieces are cut from this cloth long enough to cover the injured limb, and wide enough to surround the leg entirely ; the outer piece being one or two inches broader than the inner one. These two pieces are sewed together along their entire length with two seams about half an inch apart. The injured leg is then laid upon the cloth, so that the seams lie under the middle of the limb ; the inner piece is then brought over the limb so that its edges meet in front, where they are fastened by means of a few coarse stitches. The limb is thus enveloped in a garment which should fit it closely like a stocking. The edges along the seam in front are trimmed off even with the surface. The plaster of Paris is mixed with water so as to have the consistency of cream ; it is then spread upon the outer piece of the bandage, which has not yet been applied to the limb. The plaster should be about half an inch thick, and after it has been evenly spread, the outer piece containing it is brought over the limb and applied firmly and smoothly. The dressing thus consists of a layer of plaster between two thicknesses of cloth; the plaster does not extend entirely around the limb, since the double seam at the back leaves a space half an inch broad containing no plaster. When the plaster of Paris has become hardened, the stitches along the front of the inner layer are cut and the dressing can be opened, since the space at the back between the two seams permits a hinge-like motion. The dressing, when applied, should be kept in position by an ordinary bandage. The advantages of this dressing are several; it is easy of application, especially advantageous for an inexperienced person ; the hinge at the back not only permits the ready removal of the dressing, but also allows the splint to be loosened or tightened according as the swelling or shrinking of the limb requires. A plaster of Paris dressing made in the usual way, by the use of bandages saturated with the plaster, sometimes requires trimming as the limb shrinks. By simply cutting off half an inch or an inch from either edge along the front of the leg, we can reduce its size sufficiently to permit it to be tightly applied, even after the limb has shrunken considerably. But first, if you want to come back to this web site again, just add it to your bookmarks or favorites now! Then you'll find it easy! Also, please consider sharing our helpful website with your online friends.
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