Surgery, with Special Reference to PodiatryStern, Maximilian
Science
Surgery, with Special Reference to Podiatry
Stern, Maximilian
Foot -- Surgery; Surgery
5. Five yard rolls of ordinary and zinc oxide adhesive
plaster, three inches wide.
6. Cotton batting and sheet wadding for padding splints.
7. Strips of tin or thin cypress for strengthening plaster
casts.
The selection of a dressing for the immobilization of a fracture
depends upon, _first_, the particular bone involved and whether
apposition can be maintained with or without extension; _second_,
whether great swelling be present or not; _third_, whether the
fracture be simple or compound; and _last_, whether ambulatory
treatment be preferable to that in the recumbent position. This latter
applies, of course, only to fractures of the lower extremity.
+Operative Treatment of Simple Fractures.+ Operative treatment of a
recent simple fracture is indicated in general, when reduction cannot
be completely made; when correct apposition cannot be maintained; when
there is interposition of bone or soft parts; when the fracture is a
spiral one with considerable displacement of the fragments; when
fragments are rotated upon each other, and when there are multiple
fractures.
The most favorable time to operate in recent simple fractures is at
the end of the first or beginning of the second week. At this time the
process of callus formation is most active. The blood clots and loose
shreds of tissue have begun to be absorbed, so that the fragments are
more easily accessible.
+Methods of Fixation of the Fragments.+ In the majority of cases the
reposition of the fragments alone is not sufficient to maintain
accurate apposition. It is usually necessary to employ some means of
mechanical fixation. In all the methods employed, the preparation of
the parts is the same as for any aseptic operation. The opportunity
for serious complications resulting from septic infection, is greater
than in any other class of operations. It is for this reason that
extraordinary caution must be exercised. The incision should be large
enough to expose the seat of the fracture thoroughly.
The materials used to secure fixation are: absorbable sutures, such as
chromicized catgut or kangaroo tendon; metal suture of silver or
bronze aluminum wire; screws, nails, plates, clamps, etc.
+Injuries in the Vicinity of the Ankle Joint.+ In the examination of a
patient who shows evidence of injury in the vicinity of the ankle
joint, such as swelling, deformity, loss of function, etc., the
following conditions must be thought of, in the order given:
1. Fractures of the lower ends of the tibia and fibula
(Pott’s Fracture).
2. Dislocation at or near the ankle.
3. Fractures of the tarsal bones.
4. Rupture of the tendon Achillis.
5. Sprains of the ankle.
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