First Aid Rule.—Pain is immediate and intense. Separated fragments may be felt at first. Swelling prompt and enormous. Even if not sure, follow these directions for safety.
Prepare splint: thin board, four inches wide, and long enough to reach from upper part of thigh to just above ankle. Pad with folded piece of blanket or soft towels. Place it behind leg and thigh; carefully fill space behind knee with pad; fasten splint to limb with three strips of broad adhesive plaster, one around upper end of splint, one around lower end, one just below knee.
Lay large flat, dry sponge over knee thus held, and bandage this in place. Keep sponge and bandage wet with ice water. If no sponge is available, half fill rubber hot-water bottle with cracked ice, and lay this over knee joint. Put patient to bed.
Fracture of kneepan is caused either by direct violence or muscular strain. It more frequently occurs in young adults. Immediate pain is felt in the knee and walking becomes impossible; in fact, often the patient cannot rise from the ground after the accident. Swelling at first is slight, but increases enormously within a few hours. Immediately after the injury it may be possible to feel the separate broken fragments of the kneepan and to recognize that they are separated by a considerable space if the break is horizontally across the bone.
Fig. 26.
A BROKEN KNEEPAN (Scudder).
A padded splint, supporting knee, is shown reaching from ankle to thigh. Note number and location of adhesive plaster strips.
Nothing can be done to set the fracture until the swelling about the joint has been reduced, so that the first treatment consists in securing immediate rest for the kneejoint, and immobility of the fragments. A splint made of board, about a quarter of an inch thick and about four inches wide for an adult, reaching from the upper part of the thigh above to a little above the ankle below, is applied to the back of the limb and well padded, especially to fill the space behind the knee. The splint is attached to the limb by straps of adhesive plaster two inches and a half wide; one around the lower end of the splint, one around the upper part, and the third placed just below the knee. To prevent and arrest the swelling and pain, pressure is then made on the knee by bandaging.
One of the best methods (Scudder's) is to bind a large, flat, dry sponge over the knee and then keep it wet with cold water; or to apply an ice bag directly to the swollen knee; a splint in either case being the first requisite. The patient should of course be put to bed as soon as possible after the accident, and should lie on the back with the injured leg elevated on a pillow with a cradle to keep the clothes from pressing on the injured limb. (See cut, p. [110].)