4. Sling.
Step 1. The splints must be prepared.
Wooden and wire gauze splints are double. One, inside the arm, reaches from the axilla to the wrist, the forearm being bent to a right angle. The other extends, on the outside, from the deltoid to the wrist. They are better if provided with hinges opposite the elbow, so that their angle can be altered, if desired, in the later stage of the treatment. Splints of wood or wire gauze must be evenly and lightly padded before application.
Step 2. Bend the arm to a right angle with the thumb upwards. An assistant next reduces the fracture, and holds it in position. Then apply the splints. When adjusting the inside splint, care must be taken that the internal condyle is eased from pressure by sufficient padding above and below it. Next fasten on the splints by a roller begun at their lower end, leaving the hand free, and carried up to the elbow. Before turning round that joint a soft pad must be placed in the hollow of the elbow to push the lower end of the humerus back, and the length of the arm should be measured against the unbroken one to make sure that the shortening is reduced. Extension is kept up the whole time the splint is being fixed to the arm, which is done by carrying the roller round the elbow with figures of 8 and simple spirals up to the axilla, where it is finished off.
Step 3. Lastly, the forearm is supported in a sling under the wrist, leaving the elbow free (as in fig. 35, page [52]).
After three weeks of complete immobility, passive motion should be applied to the elbow daily, during a fortnight or three weeks more in which the splint is still worn.
If the displacement returns very easily, it is better to use an L-shaped splint passing behind the arm and below the forearm. This may be made of wood, or of leather, or of gutta-percha, in the mode about to be described.
The L-shaped splint of gutta-percha, or leather, is made as follows:—
Apparatus.—1. Sheet gutta-percha ¼ inch thick.
2. A tray or wide wash-hand basin.