Starch Bandage.—The following mode of applying the starch bandage and pasteboard splints may be used in all varieties of fracture; the length of the splints and the number of joints that should be included depend on the bone that is broken.
Some surgeons apply the starch apparatus immediately after the fracture has happened, others wait until partial union is procured and the irritability of the muscles has subsided.
Apparatus.—1. Sheets of bookbinder’s millboard.
2. Rollers suitable for the size of the limb.
3. Cotton wool.
4. A basin of freshly scalded starch.
5. A long strip of plaster, to reach as high as the bandage will extend up the limb.
6. If the fracture be recent, a wooden splint will generally be necessary to keep up extension while the starch is drying.
As a general rule, the joint at the lower end of the fractured bone should always be fixed, and that at the upper end also, if the fracture is near that point. For an example of the mode of fitting, let us suppose the femur is broken between the middle and lower thirds as in fig. 56.
Step 1. The limb is first measured for the splints. The length from the top of the sacrum to the heel, from the tuber ischii to the inside of the foot, and from the iliac crest to the outside of the foot, should be taken, and three strips of millboard prepared of corresponding lengths; the posterior one being 3 inches wide above and 2 inches, or, if the limb is small, 1½ inches wide at the heel. The inner and outer strips of similar width must be cut with side pieces for the foot, and these side-pieces stop short of the roots of the toes. For a child’s thigh, the foot need not be included, it suffices for the splints to reach the small of the leg, though to prevent shortening in an adult it is usually necessary to include the whole limb. The splints are readily cut, by first marking on the sheet of millboard, the required width and length of the strips, then bending the sheet over the edge of a table along these lines. The two lateral splints may be first taken from the sheet in one wide strip, after allowing for the foot-piece; the two strips are separated through a diagonal line, so that the broad end of one splint is taken from the other (see fig. 55).