SPECIAL FRACTURES.
Fracture of the Skull is caused by blows or falls. The external signs are not always present. In fracture of the base there may be hæmorrhage from ear, mouth, or nose; red patches of blood under conjuctivæ of eyes; and oozing of watery fluid from the ears. Accompanying these there may be symptoms of concussion, or symptoms of compression.
Treatment. Place the patient in a dark and quiet room on his back, with head slightly raised. Apply cold to head as soon as reaction sets in and patient gets hot and feverish, and send for a surgeon.
Fracture of Lower Jaw (Fig. 23, plate V.), is caused by direct blows; falls on chin. The symptoms are irregularity in the line of the teeth and the outline of the lower margin of bone; inability to move jaw. The treatment is simple. First fix lower jaw to upper jaw by a bandage, until the Bone-setter or surgeon connects the fractured parts.
Fracture of Collar-Bone is caused by blows on shoulder; falls on elbow or hand. It is a frequent accident, and when it occurs the shoulder sometimes drops; finger along the arm is helpless, and there is an irregularity on drawing surface of bone; a pad should be placed in arm-pit, bind the arm to side just above elbow, and sling forearm, as when a “shoulder is out.”
Fractures of Ribs are variously caused by blows, falls, weight passing over chest or back; there is pain and difficulty in breathing, and the usual signs of fracture. All that can be done at first is to apply a broad roller bandage firmly round chest, so as to prevent all movement; or strap the injured side with adhesive plaster.
Fracture of the Humerus (Fig. 21). It is caused by direct falls on elbow (fig. 26). The symptoms are mobility at seat of fracture, crepitus, or crackling, shortening, usually present when fracture is oblique, as in fig. 25. Apply first a roller bandage from hand to elbow, abduct arm and apply three or four splints from shoulder to elbow. Support arm in a sling. If there is looseness about the part apply a splint; if the flesh is broken stop the bleeding as directed elsewhere; if, however (as is often the case in a fracture of the forearm), there is no particular looseness of the bones, the case may be treated as dislocations and injuries to muscles, ligaments, &c. (see page 36.)
Fracture of the Forearm is variously caused by direct violent blows, falls, &c. The symptoms are crepitus, mobility, alteration in shape of arm (fig. 27), and in treating it, semiflex forearm with thumb pointing outwards. Apply two splints, one in front from bend of elbow to the tips of the fingers, and one behind from elbow to knuckles. The splints should be well padded. Place arm in sling.