The essentials of bandaging: $b including the management of fractures and dislocations, with directions for using other surgical apparatusHill, Berkeley
Science
The essentials of bandaging: $b including the management of fractures and dislocations, with directions for using other surgical apparatus
Hill, Berkeley
Bandages and bandaging; Dislocations -- Treatment; Fractures -- Treatment; Surgery, Minor
_When the shaft of the radius is broken high up_ (a rare accident)
the displacement is sometimes very difficult of reduction unless
the wrist be well supinated. To preserve this position it may be
necessary to use a wooden angular splint, and to fix the vertical
part to the arm behind the elbow, while the horizontal part is
carried along the back of the forearm.
=Fracture of the Olecranon.=—This fracture, if seen early before
effusion takes place, may be put up at once, but if delay till the
joint is swollen has occurred, the limb must be kept quiet on a
pillow, or on a splint in an easy position with evaporating lotions,
until the effusion is absorbed, before any means can be taken to
restore the position of the olecranon. Though the straight position
of the elbow is usually employed, it is not essential for even very
close union of the fragments.
In treating this fracture the following plan is useful.
_Apparatus._—1. Straight hollow splint.
2. 2-inch rollers and finger rollers.
3. Pad, wool, and lint.
4. Strapping plaster.
5. Pins.
Step 1. Bandage the fingers; wrap the hand in cotton wool and bandage
it. When the wrist is passed, fasten the bandage for a time by a pin,
and straighten the arm.
Step 2. Push the olecranon down as close as possible to the rest of
the ulna, and put a dossil of lint over it. Place the middle of a
strap of plaster an inch wide and 16 inches long, on the lint, and
carry its ends round the forearm in a figure of 8; to some extent
this alone fixes the fragment.
Step 3. Continue the bandage up the forearm by reverses, keeping the
elbow straight; and pass the joint by figures of 8 carried over the
compress of lint and the forearm, to draw down the olecranon (see
fig. 32). When this is secured, prolong the bandage to the deltoid,
to confine the action of the triceps muscle.
Step 4. Pad lightly a hollow splint about 2 inches wide, reaching
from the axilla nearly to the wrist, and apply it along the anterior
aspect of the limb, then fix it by a second roller. This completes
the apparatus.
[Illustration: Fig. 32.—Bringing down the Olecranon with Figures of
8.]
The splints and rollers should be removed on the fourth or fifth day,
that the positions of the fragments may be examined and the roller
again applied to draw them closer together. After ten or twelve
days, passive motion of the wrist and fingers, with pronation and
supination of the radius, should be adopted, but great care is to be
taken that the patient does not inadvertently bend the elbow joint
while free of the splint. The splint must be worn, with the frequent
removals directed above, for five weeks, by which time gentle flexion
of the elbow may be practised.
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