Surgery, with Special Reference to PodiatryStern, Maximilian
Science
Surgery, with Special Reference to Podiatry
Stern, Maximilian
Foot -- Surgery; Surgery
In fractures of the leg, after the application of the emergency
splint, the patient should be transported in a recumbent position, the
support being as firm as possible, a wide board, shutter or a wooden
rail being preferable. If such supports are not at hand, and the
patient is to be moved without their use, the persons transporting the
invalid should be distributed in the following manner: one supporting
the head and shoulders, a second the pelvis, and the third the two
limbs.
+Reduction.+ The reduction of a fracture is the effort made by the
surgeon to overcome any tendency to displacement, and thus to place
the fragments in such close apposition that an accurate and firm union
is possible. The best time in general for the reduction of a fracture
is as soon as possible after the accident, if the patient’s general
condition will permit. If there is marked displacement of fragments,
so that there is danger of necrosis of the overlying skin or of damage
to the adjacent vessels or nerves, an early reduction is imperative.
In all cases in which reduction is very painful or difficult, whether
performed shortly after the accident or at a later period, it is best
to administer an anesthetic to overcome muscular contraction and to
decrease the amount of pain. After reduction of a fracture, retentive
apparatus is indicated in order to maintain apposition. In the use of
dressings there will be two kinds, those which are temporary and those
which are permanent. The former are employed where the swelling of the
limb is such that some dressing can be employed which will not cause
pressure.
Certain general principles should be followed in the use of splints;
for instance, a splint, after being applied, should not interfere with
the circulation, allowance always being made for the swelling of the
limb, which almost invariably occurs during the first week. The
splint, if flat, should be wide enough to obviate the possibility of
pressure against the point of fracture; also, it should project a
little beyond the limb.
In general, it is best to immobilize the adjacent joints, above and
below the seat of fracture, but no dressing should be permitted to
remain so long as to produce stiffness of the joints and muscular
atrophy.
The skin, even in simple fractures, must be cleansed with green soap,
water and alcohol. If blebs or an area of threatening necrosis of the
skin exist, they should be freely dusted with powdered boric acid and
a few layers of aseptic gauze applied.
The form of retentive apparatus to be employed will vary, of course,
with the individual bone requiring treatment.
The most important articles of a fracture equipment are as follows:
1. Plaster of Paris bandages for making molded splints and
circular casts.
2. A stock of basswood, three-sixteenths of an inch thick, for
making wooden splints.
3. An assortment of metal splints or materials for making
them.
4. Muslin for bandages and slings.
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