Fig. 42.—McIntyre’s Splint slung in Salter’s Cradle.
Step 4. An assistant grasps with both hands the foot and foot-piece, and pulls them downwards until the shortening is removed. While doing this, he tilts the foot up or down as the surgeon finds necessary for adjusting the fragments, who also bends the knee and raises or lowers the foot until a good position is attained. The general rule is to keep the great toe in a line with the patella. This done, the surgeon tightens up the screw-pin of the foot-piece, and completes the attachment of the foot by continuing his roller with figures of 8 round the foot and ankle; these turns should not however pass above the fracture, and be no more than sufficient to secure the position of the foot and of the lower fragments (see fig. 42).
Step 5. The bandaging usually ceases with what has been already done; but if the limb swell, a separate roller may be carried along the leg to support the muscles and restrain œdema, otherwise the leg is best left bare, that the position of the fragments may be watched, and evaporating lotions applied.
Fig. 43.—McIntyre’s Splint raised on a Block.
Step 6a. This consists in slinging the limb, for which Salter’s Cradle is very convenient (see fig. 42), or an ordinary bed cradle answers very well, from which the limb can be slung on pieces of bandage carried underneath the splint at the knee and ankle.
b. Instead of elevating the limb by a sling, it is also customary to raise and fix the splint on a block (fig. 43), 6, 8, 10, or even 12 inches high, as may be necessary; this block slides in a groove on a board 3 feet square, put between the mattress and bedstead, to afford a firm support for the block.
In ordinary cases the limb is kept on the splint three weeks, until the irritation has subsided, and partial union is attained; the splint may then be replaced by a starch bandage, and the patient may leave his bed.
Transverse Fracture of the tibia alone, or even of both bones, when the displacement is small, is very well treated by a hollow splint on each side. Both splints are cut away opposite the malleoli, and the foot-piece of the inside one should not extend beyond the tarsus; that of the outside passes to the toes. The splints reach on each side to the head of the tibia, but ought not to extend above the knee-joint (see fig. 44).
