213 MEDICAL By MARY WESTAWAY (Associate of the National Health Society) Fractures— Comminuted Fractures— Complicated Fractures— General Treatment of Fractures- Extemporised Splints, Bandages, and Slings As far as the treatment of fractures is con- -**• cerned, it must suffice if it is generally understood that the human body is built up on a foundation, or framework, of bones, which may be broken by direct violence, such as a blow, or by indirect violence such as is found when the collar-bone is broken by putting out the hand to save oneself when falling. The character of the bones varies with the age of the individual, because bony tissue, which in the new-born infant is like gristle, is gradually built up by deposits of lime, from food, until the bone becomes firm and hard. Even then tlie deposits of lime are continued, and, as age advances, the bones become more and more brittle. On this account, the bones of the aged break more easily than those of the young, and mend more slowly. The mending of a fractured bone is not in any doctor's power ; the healing is entirely the with an antiseptic liquid, such as boric acid solution. 3. Comminuted Fractures may be simple or compound. The word simply means that the bone has been broken in more than one place. 4. Complicated Fractures are those in which the broken bone injures the surrounding parts, as by tearing a blood-vessel or nerve or by piercing an internal organ. 5. Green-stick Frac- tures occur only in young children, particularly among those suffering from rickets. The bone, instead of snapping like a piece of dry wood, is split along its surface just as a young twig breaks. Detecting Fractures In detecting a fracture, the following signs should be observed : I. The patient, if able to speak, complains of great pain, and tells of a snap or crack at the injured part. work " of Nature,' and Fig. 1. How to tie bandages for a fractured lower jaw 2. The broken limb is is accompanied by the throwing out of a " callus," which acts as a cement and joins the fractured surfaces, pro- vided only that the fractured ends of the bone are kept at rest with regard to each other. Thus, all that a doctor can do is to set the bone in its proper position, and make it rigid with splints, so that healing may proceed without interruption. Varieties of Fractures The student of first aid must understand the varieties of fracture and their relative danger, in order to appreciate the importance of careful treatment after an accident. 1. Simple Fractures are those in which the bone is broken through without being dis- placed. If not disturbed, such a fracture heals itself in about six weeks. 2. Compound Fractures are those in which the end of the broken bone protrudes through the surrounding flesh and pierces the skin. Under the most favourable conditions, such a fracture will not heal in less than six months. When the fracture is compound, the wound must be covered immediately with a clean hand- kerchief to keep it from the air, and, if possible, the handkerchief should be wetted motionless, and hang.- limply. If the leg or thigh is fractured, the patient will limply fall down, and be unable to rise. With a broken leg or thigh the big toe points outwards, and if the knee-cap also points outwards, it shows that the fracture is above the knee — i.e., in the thigh. 3. There is a shortening of the limb an{l a swelling over the injured part. 4. With any attempt to move the limb a crepitus, or grating sound, may be heard. This is caused by the rough ends of the bones moving one against the other ; but, although this is one of the most certain signs of fracture, the limb must on no account be moved in order to hear it. .Qeneral Treatment of Fracture I. The most important point is to avoid moving the patient until the broken bone has been made rigid by splints. The accident must be treated on the spot. No matter where the accident occurs, be it in the roadway, in a crowded meeting -place, in the hunting-field, the football-field, or in the home, splints must be applied at once. If this rule is not strictly observed, the injury is made worse, since simple fractures are invariably turned into compound or coniplicatcd fractures, which increases
