Step 2. Bandage the fingers and thumb separately, then, putting a little wool in the palm and round the wrist, bandage the hand and forearm to the elbow, where the bandage is fastened.
Step 3. Apply the splint. First get on the cap; then put the soft pad in the axilla, filling it out if the arm-pit is very hollow with cotton wool, and bend the elbow till the hand lies on the breast of the opposite side. Then, while an assistant holds the limb and apparatus in position, fasten them all in place by continuing the roller of the forearm in figures of 8 round the elbow until the splint is well fixed to it; and carry the roller up the arm by reverses to the axilla.
Step 4. A little wool or piece of flannel having been placed in the opposite arm-pit to prevent chafing, a spica for the shoulder is then applied (see page [16]), beginning at the root of the neck and working downwards. Careful extension is continued by the assistant all the time this bandage is being put on, until the head of the bone is well drawn into the cap.
Fig. 37.—Fracture at the upper end of Humerus. The apparatus completed.
Step 5. The arm is drawn to the side, and the forearm fixed against the chest by a roller carried round the arm and trunk and over the shoulder (see fig. 37).
After three weeks the forearm may be released, but the cap and axillary pad must be continued to be worn two or three weeks longer while the arm is well drawn to the side, and the wrist carried in a sling.
Fracture of the Great Tuberosity of the humerus is difficult to treat, on account of the tuberosity being carried backwards by the muscles and the humerus being rotated forwards. Hence the parts must be braced together with a firm cap of gutta-percha moulded on to the shoulder while soft, and while the fractured parts are held in apposition, which may be done by the fingers, or by putting on a wet roller firmly over the shoulder as a spica before the splint is set. When the splint is hard the bandage may be taken off, and the splint removed and finished ready for application. In doing this, the steps are the same as for fracture of the surgical neck of the humerus, and the necessity for fixing the arm well to the side of the body as great as in that fracture.
Fracture of the Acromion is treated very much like fracture of the clavicle, that is, the arm is well raised by a sling under the elbow, and then fastened to the side. It is not necessary to fill the axilla with a pad, as in fracture of the clavicle, for in this case the shoulder is not drawn inwards.
Fracture of the Clavicle.