A compound fracture is one in which the skin, etc., is broken or cut across, so that the fracture is more or less exposed to the air. The end of either fragment of the broken bone may protrude through the skin.
A comminuted fracture is one in which the bone is broken into several pieces; such a fracture may be either simple or compound.
In a simple fracture great gentleness should be used in handling the parts, so as not to convert it into a compound fracture; therefore, do not undress the part; rather cut away the clothing.
A fracture which is compound is usually serious, for dirt and germs are liable to be carried into the wound and cause great mischief; in gunshot wounds, dirt or pieces of clothing may be carried into the wound.
The signs of a fracture are, firstly, the patient’s own feelings, e.g., the pain which is caused on handling the part, sudden loss of power, and the sensation of grating. Secondly, on examination, most if not all of the following signs will be observed: inability of patient to move the part below the injury, swelling, unnatural movement below the site of fracture, alteration in appearance of the limb.
In fractures of the upper or lower limb there is usually shortening, the spasmodic action of the muscles causing the broken ends to ride over each other, and the greater the obliquity of the line of fracture the greater will be the shortening and alteration in appearance.
A sensation of grating is usually conveyed to the operator when he attempts to move the parts; sometimes this grating can be heard, as well as felt. Comparison of the injured with the sound limb is of the greatest importance in detecting fractures.
Treatment of Simple Fractures.
Directly a fracture of a limb is made out, a splint or splints of some kind should be applied to keep the parts fairly in position, and to prevent a broken end from being pushed through the skin. Cloths and bandages may be applied firmly round the injured part, and then extemporised splints, such as boards, straight sticks, umbrellas, or bayonets, should be applied and kept in position till the patient is in bed.
Splints suitable to the injury should be now made and well covered with wool, lint, or cloth, special care being taken to pad them well where they are likely to press upon bony prominences, such as the inner or outer ankle. The limb must next be straightened, and any deformity caused by overriding of the fragments must be remedied by steady pulling upon the parts above and below the fracture, in opposite directions, and the parts brought into good position by manipulating the bones at the seat of fracture. The prepared splints, extending well below and above the fracture, are then fitted to the limb with cotton-wool or lint, and secured by bandages.