Manual of Surgery Volume Second: Extremities—Head—Neck. Sixth Edition.Thomson, Alexis
Science
Manual of Surgery Volume Second: Extremities—Head—Neck. Sixth Edition.
Thomson, Alexis
Surgery
It is in cases of this kind that the _ambulatory method_ of treatment
yields its best results. When, in the course of two or three days, the
swelling has subsided, a plaster-of-Paris case (Fig. 95) is applied in
such a way that when the patient walks the weight is transmitted from
the condyles of the tibia through the plaster case to the ground, no
weight being borne by the bones at the seat of fracture. The apparatus
is applied as follows: A boracic lint bandage is applied to the limb
as far as the knee, and protecting pads or rings of wool are placed
over the condyles of the tibia, the head of the fibula, and the
malleoli. A pad of wool about 3 inches thick is then placed under the
sole and fixed in position by a plaster-of-Paris bandage, which is
carried up the limb in the usual way. The case is made specially
strong on the sole, around the ankle, up the sides of the leg, and at
the bearing-point at the head of the tibia. After the plaster has
thoroughly set, the patient is allowed to walk about with a stick,
crutches being unnecessary. In the course of three weeks the plaster
case may be removed and the limb massaged. It is usually found that
the movements of the ankle are scarcely interfered with, and the
patient is generally able to resume work within a month of the
accident.
[Illustration: FIG. 95.--Ambulant Splint of plaster of Paris.]
When there is marked eversion of the foot, it may be necessary to
administer a general anæsthetic to reduce the deformity; and to
prevent recurrence of the displacement _Dupuytren's splint_ (Fig. 96)
may be used. This splint, which is of the same shape as Liston's long
splint, but on a small scale, is applied to the medial side of the leg
extending from just below the knee to well beyond the sole of the
foot. A large pad is placed in the hollow above the medial malleolus,
and it must be thick enough to carry the splint so far from the limb
that when the foot is fully inverted it does not touch the splint. The
upper end of the splint having been fixed to the leg at the level of
the condyles of the tibia, a bandage is applied to correct the
eversion of the foot, and at the same time to support the heel, and,
as far as possible, to overcome the pointing of the toes. Care must be
taken to avoid carrying the turns of this bandage over the seat of
fracture. The limb may then be slung in a cradle, or placed on a
pillow resting on its lateral side with the knee flexed. In the course
of a few days, a poroplastic splint may be substituted and massage
commenced.
[Illustration: FIG. 96.--Dupuytren's Splint applied to correct
eversion of foot.]
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