7. Strips of tin or thin cypress for strengthening plaster casts.
The selection of a dressing for the immobilization of a fracture depends upon, first, the particular bone involved and whether apposition can be maintained with or without extension; second, whether great swelling be present or not; third, whether the fracture be simple or compound; and last, whether ambulatory treatment be preferable to that in the recumbent position. This latter applies, of course, only to fractures of the lower extremity.
Operative Treatment of Simple Fractures. Operative treatment of a recent simple fracture is indicated in general, when reduction cannot be completely made; when correct apposition cannot be maintained; when there is interposition of bone or soft parts; when the fracture is a spiral one with considerable displacement of the fragments; when fragments are rotated upon each other, and when there are multiple fractures.
The most favorable time to operate in recent simple fractures is at the end of the first or beginning of the second week. At this time the process of callus formation is most active. The blood clots and loose shreds of tissue have begun to be absorbed, so that the fragments are more easily accessible.
Methods of Fixation of the Fragments. In the majority of cases the reposition of the fragments alone is not sufficient to maintain accurate apposition. It is usually necessary to employ some means of mechanical fixation. In all the methods employed, the preparation of the parts is the same as for any aseptic operation. The opportunity for serious complications resulting from septic infection, is greater than in any other class of operations. It is for this reason that extraordinary caution must be exercised. The incision should be large enough to expose the seat of the fracture thoroughly.
The materials used to secure fixation are: absorbable sutures, such as chromicized catgut or kangaroo tendon; metal suture of silver or bronze aluminum wire; screws, nails, plates, clamps, etc.
Injuries in the Vicinity of the Ankle Joint. In the examination of a patient who shows evidence of injury in the vicinity of the ankle joint, such as swelling, deformity, loss of function, etc., the following conditions must be thought of, in the order given:
1. Fractures of the lower ends of the tibia and fibula (Pott’s Fracture).
2. Dislocation at or near the ankle.
3. Fractures of the tarsal bones.