Pott’s fracture. (Hoffa.)
Fig. 337
Exaggerated deformity in Pott’s fracture.
Treatment of Fractures of the Leg.
—Nearly all these fractures are likely to be followed by swelling, even to a degree which makes it impracticable to put them up in permanent dressing until the swelling has subsided. This means a period of two to several days, during which the limb should be kept absolutely at rest, and the bones maintained in apposition by side splints, while the limb is restrained within a folded pillow or other comfortable cushion. More frequently here than in any other part of the body there will form blebs or large blisters, which are most liable to occur in alcoholic subjects. The leg should be scrubbed and shaved before putting on dressings, in order that the skin may be reasonably clean before its surface epithelium is raised. Ecchymosis, infiltration, and sometimes general edema may become somewhat pronounced, and the splint which would be required to fit a limb under these circumstances would soon be too large when this disturbance has subsided. The limb should not, therefore, be placed in a fixed or permanent dressing until it is in every respect ready.
While these disturbances are subsiding, or perhaps being encouraged to subside by the use of an ice-bag or of cold wet applications, extreme care should be taken that proper position and apposition are maintained. This will at times need considerable ingenuity. A delirious or maniacal patient would need restraint far beyond that required for one who is rational and docile. Moreover in all of these fracture cases which entail confinement to bed there is a tendency to deficiency of elimination which will require judicious use of laxatives and other eliminatives.
The writer prefers a well-molded set of side splints, properly padded, to any other first dressing for fractures of the leg. A limb thus dressed may be supported on a pillow and even made adaptable for transportation should it be necessary to remove the patient from one place to another. The fracture box can be well superseded by this method.
So soon as swelling has subsided, plaster of Paris should be used for a fixed dressing. The limb should be enveloped in a layer of cotton, by which the skin is protected, within which swelling may occur without much strangulation. Over this and down the front of the leg a strip of thick pasteboard should be placed, which can be moistened and made to adapt itself, or a strip of sheet tin, an inch wide, which can be made to fit the part, and upon which one may cut down later in removing the splint. This refers especially to the use of the roller bandage saturated with plaster of Paris. Molded splints can be made, as recommended for the upper extremity, out of surgeons’ lint, canton flannel, or old blanketing, while at the lower end of these splints may be incorporated, with the plaster, a strip of bandage or other material, by which a loop is formed beneath the foot, which may be utilized for the purpose of traction.