Fig. 55.—Diagram showing the mode of cutting out splints from a sheet of millboard.
When the strips are cut they should be laid on a large tea-tray, boiling water poured over them, and a minute or two later, some boiling hot thin starch; this soon soaks into and softens the millboard till it is thoroughly pliant. When somewhat softened, the edges should be thinned by peeling off little strips along them, after which some more boiling water may be poured on and allowed to soak in while the limb is prepared.
Two or three rollers should then be unwound, and passed as they are rolled up again through the basin of starch; these, thoroughly soaked in starch, are used for the first layer, dry rollers serve very well for the second layer.
Step 2. The limb is washed and dried; a strip of diachylon plaster one inch wide is laid along the front to protect the skin when the case is being cut open after it is dry; the limb is next wrapped evenly in cotton wool, putting a scrap between each toe. This is best done by unrolling a sheet of wadding, splitting the sheet into a layer of suitable thickness, which is torn into strips about three inches broad, that are then wound evenly round the limb as high as the splints will reach.
Step 3. The splints are next adjusted and moulded to the limb, being temporarily secured by a few ends of bandage tied round them. One assistant grasps the splints and foot at the ankle and keeps up extension, while another holds the thigh. The surgeon then proceeds to roll the bandages, first round the foot and ankle, and then up the leg, rubbing in the warm starch as he proceeds. Each turn of the roller should be made as tightly as possible, for when the case dries it always grows loose by the evaporation of the water it holds. As reverses are always difficult to cut through afterwards, they should be avoided, and the bandage laid on in simple spiral or figure of 8 turns. When the perinæum is reached, the surgeon wraps round the pelvis a broad strip of cotton wool, while an assistant on each side of the patient supports his body on a folded sheet or jack-towel, and a third holds the broken limb. The bandaging is then continued in a well-fitting spica, and ended by a few circular turns round the body. If the splint touches the crest of the ilium it should be shortened till it clears that point, or it will gall the patient afterwards. A fold of soft lint in addition to the cotton wool should line the splint at the perinæum, or the sharp edge of the bandage, when it is dry, will chafe there also. When the first bandage is complete, the limb should be smeared again with starch, and a dry bandage rolled over it from below upwards, which must be similarly saturated with starch as it is laid on the limb, and when finished the whole is well covered with starch.
If the fracture is recent, and no union has taken place, a long splint should be put on outside the case, fastened to the foot and extended by a perineal band, while the starch is drying, that the limb may not shorten. With children it is best to apply the wooden splint in all cases, as they are apt to wriggle about, or sit up in bed and disarrange the case while it is in a pliant condition. If the wood splint is not used, the limb should be supported in a good position by sand-bags laid along its sides.
Fig. 56.—Starch Bandage.
In three days the starch is quite dry, but the drying may be hastened by hot-water bottles or hot sand-bags laid in the bed. It must then be cut up along the front from bottom to top; it will often be found loose, especially where swelling had existed before; this is best remedied by paring the overlapping edges with scissors. If any projecting part is chafed, an accident that ought not to happen, the case may be lifted from the sore part by a little more wool laid around, not on the part pinched. The limb being in a satisfactory position, and the case fitting properly, a roller is carried up over the whole to keep it in place while it is worn (fig. 56).