Fig. 323
Fracture of the femur in a child treated by vertical extension. (Bryant.)
This method has found favor in the West under the enduring influence of Hodgen’s teaching. In the East it is not so generally practised. It has, however, several advantages, as follows: (1) Equably perfect and comfortable extension; (2) easy adjustment; (3) easy exposure for inspection; (4) when a fracture is compound it permits of easy application of dressings; (5) adaptability to nearly all fractures of the femur. It is peculiarly serviceable for feeble and aged patients who chafe at restraint. If it be desirable to flex the knee to a considerable degree this can be done, e. g., in fractures near the lesser trochanter.
In fractures of the thigh, patients are frequently disturbed by muscle spasms occurring during sleep. This can usually be obviated or minimized by suitable doses of sulphonal, given early in the evening.
Fractures of the femur in children are not uncommon. In those who still wear diapers, and perhaps in those a little older, these injuries may be best treated by vertical suspension, with sufficient weight to overcome all shortening. Here the adhesive strips and the suspending cords should be attached to both limbs alike, in order to have sufficient access to the perineum, and in order to judge of the effect which we are obtaining. [Figs. 323] and [324] illustrate this method.
Plaster-of-Paris dressings for fractures of the thigh appeal especially to those who are most familiar with the use of the material. Some patients with fracture of the neck of the femur may be early put in the erect posture, upon an elevated surface, allowing the injured limb to hang down while the patient rests upon crutches. In this upright position, with the down-hanging leg, to which traction can be made by an assistant, a plaster-of-Paris spica may be applied, extending from the waist-line down to or below the knee. As a limb is thus dressed so it will heal, and it is of importance that complete reduction be effected as a part of the procedure.
Fig. 324
Fracture of the thigh; vertical suspension. The fracture is compound in the patient on the right. (Stimson).