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Non-union of Bones After Fractures.First-A constitutional taint of the individual. Second-The coexistence of some wasting disease, such as consumption. Third-Improper dressing, as a result of which the fragments are permitted to move during the healing process instead of being held firmly in contact with each other. This is one of the most frequent causes of failure of the broken fragments to unite. Fourth-Interference with the circulation of the injured limb, in consequence of the tightness of the bandages. Fifth-The presence of some substance between the broken ends. There are certain bones after fractures of which we expect non-union ; that is, the fragments become united by ligaments, or membranes, and not by true bone. The knee-pan and the upper end of the thigh-bone are examples of this sort. In some cases of fractures of other bones also a similar union takes place by means of ligaments instead of bone; but by non-union, in general, we understand an entire failure of the fragments to unite either by liga ment or by bone. This condition is indicated by the persistence of the original signs of fracture, at least by the mobility of the fragments and by the grating sensation. Thus it sometimes happens that after a dressing has been applied five or six weeks, the fracture is found to be just as distinct and complete as at the time of the injury. Treatment.-The treatment of non-united fractures is often troublesome, and sometimes ineffectual. It requires a careful study of the patient's general condition, as well as close attention to the dressing and to the anatomy of the injured part. In some cases the fracture can still be healed if the patient be allowed to enjoy air and exercise instead of lying in bed. Thus it has often happened that the fracture of the leg, for example, which has been treated by placing it in a fracture-box, has failed to unite for four or five weeks, while the patient was lying on his back ; but when the box was replaced by a plaster of Paris splint, which permitted the patient to walk around with the use of crutches, union has promptly occurred. At other times the fracture fails to unite apparently from simple lack of vitality on the part of the patient. In such cases, the desired object can be sometimes obtained by the use of an unusually nutritious diet, and of tonic medicines. In such cases, we may prescribe with advantage quinine, iron and the hypophosphites. In a large number of cases the failure of the fragments to unite is caused by the imperfection of the dressing, as a result of which the fragments are permitted to move during the movements of the limb. It is therefore always important to secure such a dressing as will retain the fragments in perfect repose, and to see that this object is accomplished. In most cases in which a fracture has failed to unite, it is advisable to adopt some means for improving the circulation of the blood through the part. The simplest measure, one that can be easily employed, consists in removing the dressing, or at least so much of it as will expose the vicinity of the fracture, and of applying friction to the skin for half an hour every day. The surface should be briskly rubbed with the hands, and afterward some stimulating liniment, such as the compound soap liniment, should be applied and rubbed gently into the skin. If these measures fail, that is, if at the end of ten days there be no evidence of union between the fragments, more active means must be employed. These should be left to the hands of the surgeon, whenever professional services can be secured, for it is important that no time be lost, since the chances for the healing of the fragments are diminished by the lapse of time. Until the services of a surgeon can be secured, the following plan may be adopted : the dressing should be removed and the broken ends of the bone should be rubbed briskly against each other for two or three minutes, by placing the hands one above and the other below the point of fracture. The splint is then applied, and the limb kept at perfect rest. In some cases this may be sufficient to cause the fragments to unite. In most instances, however, it will be necessary to employ some operative procedure whereby an inflammation may be excited at the point of fracture, sufficient to induce the repair of the bone. Various plans are adopted for this purpose. One consists in driving ivory pegs into the ends of the bone. Another plan consists in joining the broken ends by silver wires. Sometimes the ends are sawed off so as to expose fresh surfaces. These operations can, of course, be performed only by a surgeon. If it be impossible to secure surgical skill, the patient must be content to wear some apparatus which shall serve as a substitute for the bone, and shall give the required stiffness to the limb. Another accident which sometimes complicates the healing of a fracture is " bad union. " By this we mean that although union has occurred between the fragments, yet the limb heals in such a way as to impair materially its usefulness. Bad union occurs if the bone is not properly set at the beginning, or if the dressing be so loose and ill applied as to permit the fragments to acquire a new and improper position. As a result the limb may be so crooked or deformed that it is of but little service to the patient. If this be discovered before the bones have firmly united-say in the first two or three weeks after the injury - the position can be remedied by simply setting the bones over again and applying a dressing which shall hold them firmly in position. If the mistake be not discovered until the fragments are firmly united, there is still a way to correct the deformity. This consists in putting the patient to sleep with ether and then in breaking the bone again by main force. After this the limb is placed in a proper position and dressings firmly applied in such a way as to prevent a repetition of the former misfortune. It sometimes happens that a limb which is perfectly straight and apparently healed when the splints are removed, bends and becomes deformed within a few days afterward. It is sometimes possible to remedy this by placing the limb in the splints again for another week or two ; but in many cases the form of the limb can be restored only by breaking the bone again and treating it as a new fracture. To avoid such an accident the patient should be careful not to subject the newly-united bone to any severe strain for several weeks after the dressing is removed. If the broken member be the thigh or the leg, he should be careful to employ crutches and canes, so as to relieve the bone from the weight of the body. If the injured limb be an arm or a forearm, it should be carried in a sling for a week or two after the union appears to be complete. 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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