Fig. 25.—Showing the method for supporting externally the jaws in the splint, when the teeth are not fastened to it by screws, E. Upper wing; G. Lower wing; H. Mental band to keep the jaw up in the splint; I. Neck-strap to keep the band back; K. Balance-strap to hold skull-cap in place. The upper wings are of course dispensed with, when a single splint only is used.
When the displacement is considerable the fragments are held in place by riveting one or more teeth to the cap, or, when circumstances prevent support being obtained in this way, external support is supplied to the splint by steel wings, fixed into the splint at the angles of the mouth (see fig. 25), and carried outside the cheek to the angles of the jaw. A piece of stout jean or canvas, cut to fit under the chin, is then connected with these wings, and also fastened by a tape behind the neck.
If the case require that a bearing be made on the upper jaw as well as the lower one, as in fracture of both jaws in edentulous persons, the two splints are articulated behind, so that they may open and shut with the lower jaw. Each piece then carries a wing, the lower one supporting a chin-piece, and the upper one being connected by strings attached at the temples to a close-fitting skull-cap. The skull-cap is prevented from slipping forward by connexion with a strap fastened to both shoulders.
A fractured Rib is very well treated by strapping the injured side alone, without enrolling the chest in a tight bandage, which harasses the patient by impeding respiration.
Apparatus.—1. Diachylon plaster.
2. Can of boiling water.
Fig. 26.—Strapping a broken Rib.
Strips of plaster long enough to reach from the spinal column to the sternum, and 2 inches wide, are to be firmly drawn round the injured side. The first strip should be carried as high as can be managed under the arm-pit. The next strip overlaps it about an inch (fig. 26), each succeeding strip overlapping and fixing the preceding one until the lower ribs are covered in. The arm should then be bandaged to the side, and supported in a sling.
A second mode of treating fractured ribs, is to take a flannel roller 6 inches wide, and 8 yards long, and carry it firmly round the chest in successive spirals, beginning at the armpits, and passing down till the waist is reached. The turns of the roller may be kept from slipping down by throwing across the shoulders two strips of bandage like a pair of braces, and stitching each turn to the brace in front and behind. The arm should be confined to the side as in the other method. This plan has the inconvenience before mentioned of interfering with respiration.