Backwoods Surgery & Medicine

by Charles Stuart Moody

The most appalling accident that can befall a man isolated from skilled surgical aid is the fracture of a limb, especially of the leg, and yet this is one of the commonest of all woods misfortunes.

Before proceeding to the discussion of individual fractures, a brief consideration of the classification and detection of fractures in general is necessary. Surgeons divide fractures into: simple, those where there is a simple separation of the bone without injury to the flesh; compound, where in addition to the separation of the bone there is laceration of the flesh and one or both ends of the bone are driven out through the skin; and comminuted, where the bone is in several fragments. A comminuted fracture may be either simple or compound, according as it does or does not penetrate the flesh.

The symptoms of fracture are pain, loss of motion, change of position, change of contour of the fleshy parts, and most important of all, a light crackling sound when the limb is moved—crepitation the surgeons call it.

Pain following an injury that might produce a fracture is not necessarily proof positive of the existence of a fracture. Pain may and often does follow a bruise, sprain, or dislocation, in a greater degree than that following a fracture. Loss of motion, too, is quite as marked in dislocations and severe sprains as in fractures. Change of contour, unless in the locality of prominent joints, is quite a valuable sign. The fractured limb, except in certain rare cases, will show a change in the appearance of its general outline.

By crepitation is meant that characteristic grating sound produced by rubbing the two ends of the fractured bone together. It is the one absolute sign of a fracture, and once heard can never be forgotten. It may be likened to the sound produced by rubbing two or three coarse hairs between the finger and thumb.

If a fracture is suspected let the patient himself, or some one for him, grasp the limb above and below the site of the suspected fracture and turn it in opposite directions. If a fracture is present it will be manifested by a distinct grating sound, also by a jarring sensation as the uneven fragments pass over each other.

A description of all the fractures of the different bones of the body would be manifestly out of place in a book of this character, so I shall confine myself to those most liable to be encountered in the woods—that is, fractures of the leg, thigh, forearm, and arm. Fractures of the leg or thigh will entail an enforced stay of from four to six weeks in the woods, or the devising of some means to transport the patient to a place where he can have proper care, an arduous task in a country where there are no roads and the trails are difficult. If a personal experience may be allowed, I will tell how I once treated a man with fractured thigh and conveyed him with comparatively little discomfort over sixteen miles of rugged mountain trail and some forty miles of equally rugged mountain road.

I found the man in a mining camp in the very heart of the higher mountains, lying in his bunk with a badly fractured thigh. The bone was separated between the upper and middle third—that is, up toward the body. The accident had occurred some twenty hours previous and there was much swelling, which it was necessary to reduce before anything else could be done. This was accomplished by the application of cold water by means of strips of blanket, changing the application as fast as the water became warmed by the body heat.

In the meantime I went out into the timber and felled a small cedar tree some six inches in diameter. From this I cut a section five feet in length and removed the bark. Splitting the bark in half, I rounded up the edges and made a splint for the outside of the limb extending from the armpit to six inches below the foot. The other half was made into a similar splint, only shorter, for the inside of the limb, extending from well up into the groin to a point opposite the outer splint below the foot.

It was necessary to cut holes in the splints where the bony prominences came. When all was in readiness and the limb reduced in size, I wrapped it well in soft cloth, having no absorbent cotton, and applied my splints. I had a man stand at the feet of the injured man, take hold of the injured leg, and pull steadily while I manipulated the fracture.