Treatment. The treatment in such fractures is by immobilization in a posterior metal or plaster splint, for four weeks. If there is continual pain upon walking after the injury, a steel insole will often give relief. The treatment of compound fractures of the metatarsal bones does not differ from that of other bones.
Dislocations. A dislocation is a displacement from each other of the articular ends of the bones which enter into the formation of a joint. A diagnosis can usually be made from certain objective and subjective symptoms, taken in conjunction with an accurate history of the manner in which the accident occurred.
Examination should be made in a systematic manner in every case, us follows:
(1) Inspection. The limb should be first inspected to note the position, the alterations of contour, or of the axis of the limb, or the projection or absence of certain bony prominences. The position is often so characteristic that a diagnosis can be made by inspection alone.
(2) Palpation. By this one can learn the relation of the displaced articular ends to each other, unless the swell ing is too great, or the patient is very stout. This method also enables one to ascertain the absence of normal prominences or the presence of abnormal ones. The end of the displaced bone may be felt in an abnormal position.
(3) Measurement. The limb may only appear to be or is actually shortened. In the latter event the normal measurements between bony prominences will be altered.
(4) A skiagraph should be made in all doubtful cases to confirm the diagnosis of dislocation, and also to ascertain whether there is an accompanying fracture.
When the patient is stout, or when considerable swelling exists the use of the X-ray is of especial value.
The attitude of the limb is often so characteristic that simple inspection will enable one to make a diagnosis by this means alone. In stout persons, a change in the axis of the limb or a change in position is apt to be overlooked. The relation of the articular surfaces can be determined by palpation, unless the swelling is too great. Measurement of the limb will usually show a shortening, depending upon the position in which the limb is held. The movements of a dislocated joint are usually limited. If any movement of the end of one of the bones is felt, it is always at an abnormal point. Pain is referred to the dislocated joint and the patient is unable to use the limb.
Treatment. As a rule, a dislocation should be reduced as soon as the diagnosis is made, and, if necessary, an anesthetic should be administered.