Bone fracture

“ A fracture of a bone, however simple it may be in its nature, is said to be compound when accompanied by an external opening in, or a wound of, the soft parts, communicating with the broken bone—a complication which usually gives rise to ulcerative inflammation and suppuration throughout the whole extent of the injury, preventing thereby those milder processes being effected which, under the more favorable circumstances of the skin being unbroken, lead to a speedy union of the broken parts ”

“ Lastly, with regard to suppuration, only a small proportion of the fractures, accompanied by the presence of large wounds, escaped infection. When infection did occur, the results offered some special features dependent on the small relative amount of damage to the soft tissues, compared with that suffered by the bone. In an ordinary compound fracture, such as we meet with in civil practice, whether the result of direct or indirect violence, a considerable amount of contusion or laceration, as the case may be, accompanies the injury to the bone. ”

“ When one bone is broken there may be only a point of tenderness and swelling about the vicinity of the break and no displacement or grating sound. When in doubt as to the existence of a fracture always treat the limb as if a fracture were present. ”

“ A pathological fracture has as its primary cause some diseased state of the bone, which permits of its giving way on the application of a force which would be insufficient to break a healthy bone. It cannot be too strongly emphasised that when a bone is found to have been broken by a slight degree of violence, the presence of some pathological condition should be suspected, and a careful examination made with the X-rays and by other means, before arriving at a conclusion as to the cause of the fracture. ”

“ A broken bone is called a fracture. The great danger in the case of a fracture is that the sharp, jagged edges of the bones may stick through the flesh and skin, or tear and bruise the arteries, veins, and muscles. ”

“ This makes it more dangerous as the possibility of infection by germs at the time of the accident, or afterward, is added to the difficulty of the fracture. [179]
Symptoms—As in dislocation, you should be familiar with the main symptoms of a broken bone.
1. When you look at the injured part it may or may not look like its mate on the other side. In the more severe fractures it usually does not.
2. When you try to move it you find more motion than there should be, if the bone has broken clear through; that is, there will seem to be a joint where no joint should be. ”

“ A fracture is the same thing as a broken bone. When the bone pierces through the skin it is called a compound fracture. When it does not, a simple fracture.
If you have to deal with a broken leg or arm, and can't get a doctor at once, make the patient lie down.
Place the leg in the same position as sound one, and hold it in splints made of anything that is stiff and rigid like a flat board (that is better than a round pole) or a limb broken from a tree. Shingles make excellent splints. ”

“ In cases of fracture in either of the bones of the forearm, it is easier to effect a cure if the upper bone be broken, although it be the thicker one, both because the sound bone is situated below, and forms a support to it, and because the deformity is more easily concealed, there being a thick mass of flesh on the upper side, except near to the wrist. But the lower bone is without a covering of flesh, is not easily concealed, and requires stronger extension. ”

“ In due course of time the fracture united, and the patient got about with some shortening of the limb, and walked with perfect facility for one year, when, in crossing the street, he fell and broke the same bone again about four inches, so they told me, below the seat of the former fracture. Neither of the physicians who had attended him on the previous occasion being in the city, a third medical man, a surgeon of national reputation, was called, who proceeded to apply the proper bandages for fracture. ”

“ Consequences dreadful to the patient have too often followed blunders in diagnosis. As in the accidents of the shoulder-joint, some idea as to the exact injury may be formed by ascertaining how the force was applied; but this, alone, may sometimes mislead. Careful manipulation is to be chiefly trusted to.
Fracture within the capsule is met with most frequently in those of advanced age, when the form of the neck of the bone has been altered,—when it has become shorter, and attached less obliquely to the shaft, as is sometimes the case; the bones, too, are then more brittle than in earlier life. ”

“ The evil consequences of false diagnosis, and of treatment formed thereon, are very apparent. A dislocation may be put up and treated as a fracture, perhaps till too late for reduction; and the patient will possess but weak and imperfect motion of the limb, after having undergone long suffering. On the contrary, dreadful torments are inflicted on the patient when fracture is treated as luxation. The force applied with the view of reduction is in all circumstances very painful, but, when exerted on a fractured bone, must prove absolute torture ”

“ It may be important to determine whether a bone was fractured before or after death. This point can not always be decided. Fractures inflicted during life are, as a rule, attended with more extravasation of blood and evidences of reaction in the surrounding tissues; but fractures produced within a few hours after death may resemble these very closely. Usually a greater degree of force is necessary to fracture bones in the dead than in the living body. ”

“ Atrophy of bone may proceed to such an extent in old people, or in those who for long periods have been bed-ridden, that slight violence suffices to determine a fracture. This most frequently occurs in the neck of the femur in old women, the mere catching of the foot in the bedclothes while the patient is turning in bed being sometimes sufficient to cause the bone to give way. Atrophy from the pressure of an aneurysm or of a simple tumour may erode the whole thickness of a bone, or may thin it out to such an extent that slight force is sufficient to break it. ”

“ In either case there is a communication between the external air and injured bone, and the probability arises of the germs of suppuration finding their way to the seat of fracture. This greatly increases the risks of the case, for septic inflammation and suppuration may lead to delayed union, to death of large pieces of the bone (necrosis) , and to osteomyelitis and to blood-poisoning. In the treatment of a fracture, every care should be taken to prevent any sharp fragment coming near the skin. Careless handling has often been the means of a simple fracture being converted into a compound one. ”

“ Simple Fracture is a condition where the continuity of the bone has been broken without serious destruction of the soft structures adjacent, and where no opening has been made to the surface of the flesh. Such fractures do not reduce the bone to fragments. Long bones are frequently subjected to simple fracture, while short thick bones, such as the second phalanx, may suffer multiple or comminuted fractures. ”

“ This fracture is situated in the left half of the frontal bone, but, inferiorly, it extends somewhat over the median line. In form it is about quadrilateral; and it measures 21⁄2 x 13⁄4 in. Two large pieces of bone are seen to have been detached and upraised; the upper one having been separated at the coronal suture from the parietal bone, and being so closely united that the fracture does not show upon the outer surface. The lower piece shows the line of fracture all around. Owing to the loss of bone, two openings are left in the skull ”

“ Fractures are generally the result of great force applied directly to the shaft of a bone, or to its extremity; but they are also not unfrequently caused by twisting of the limb whilst the muscles are in a powerful action. Bones are broken transversely; but more frequently there is a degree of obliquity in the fracture, and the fragments are generally detached. A bone may be split longitudinally, as from a musket-ball striking its shaft in the centre ”

“ Fracture of one bone, at a point lower in the limb, is not attended with much displacement or deformity. Indeed, attentive manipulation is often required to detect the site of the injury; and a sense of crepitation is perceived, only when the lower and upper portions of the bone are pressed on alternately or during rotation of the foot. When both bones are broken, the displacement and swelling are great. The foot is sometimes turned inwards, but usually it falls outwards ”

“ Some enumerate also the capillary fracture, but it is a very narrow fissure which eludes the senses, and therefore, being often overlooked owing to the symptoms of it not being obvious, it occasions death. An indentation is not a division of a bone, and, therefore, such an injury is not properly called a fracture, but is, as it were, a protrusion and bending of the skull inwardly, forming a hollow without a solution of continuity, as when vessels made of copper, or the raw hide of an ox, are struck on the outside. ”

“ The fractured limb is pulled away from the body with considerable force in order to overcome the displacement; over the fractured bone is wound a thick layer of cotton wool, and over this are applied a number of small round, straight sticks, completely surrounding the limb, their centers corresponding nearly to the seat of fracture; these are kept in place by a firm binding of henequen cord. The limb, if an arm, is supported in a sling; if a leg, the patient is confined to his hammock till the fracture is firmly knit. ”

“ Swelling, with spasmodic of these symptoms may be wanting; there is little deformity, and no shortening, when one of two or more action of the muscles, soon takes place. One or several parallel bones is fractured. In fracture of the extremities, extrication of air into the cellular tissue, about the ends of the bone, is not unfrequent, though difficult to account for—giving rise to crepitation, superficial, and quite a distinct sensation from that imparted by the broken bone. ”

“ Special Fracture in Young People.—The long bones of children and growing persons consist of a shaft with cartilaginous ends in which bone is developed. As the result of injury, the end of the bone may become detached, a variety of fracture known as diastasis. Such a fracture—however well treated—may be followed by arrest of growth of the bone or by stiffness of the neighbouring joint. ”

“ He insisted on the most exact co-aptation of fractured bones, declaring that it was disgraceful to allow a patient to recover with a crooked or shortened limb. His splints were probably quite as good as ours, and his bandaging left nothing to be desired. When the ends of the bones projected in cases of compound fractures, they were carefully resected. In fracture of the skull with depressed bone the trepan was used, and in cases where blood or pus had accumulated they were skilfully evacuated. He boldly and freely opened abscesses of the liver and kidneys. ”

“ The existence and situation of a fracture can often be recognized long after the accident, by the callus or slight unevenness due to projection of the edges or ends of the fragments. Where the bone lies deeply covered by soft parts, it is difficult and often impossible to tell, long after union has taken place, whether or where a fracture has occurred. ”

“ Wedge-shaped fractures of this bone were apt to show multiple secondary wave fissures concentric with the main line, and consequently free comminution. I saw several examples, the loose fragments being remarkably numerous. Plate XIX. is an example of an oblique fracture produced by a bullet which has ploughed across the bone, displacing large fragments anteriorly, but finely comminuting the bone in its course, and leaving small fragments of the mantle on its way. Plate XX. is an example of the rare condition of transverse fracture. ”

“ It is maintained, therefore, that the disposition to fracture does not depend upon a fragility of the bone, but on the loss of the muscular sense and of common sensation in the bones, as a result of which there is an inability properly to throw the muscles into action and dispose the limbs so as to place them under the most favourable conditions to meet external violence. ”

“ Cotton wool.
4. A basin of freshly scalded starch.
5. A long strip of plaster, to reach as high as the bandage will extend up the limb.
6. If the fracture be recent, a wooden splint will generally be necessary to keep up extension while the starch is drying.
As a general rule, the joint at the lower end of the fractured bone should always be fixed, and that at the upper end also, if the fracture is near that point. For an example of the mode of fitting, let us suppose the femur is broken between the middle and lower thirds as in fig. 56.
Step 1. The limb is first measured for the splints. ”

“ When necrosis is extensive, there is a risk of fracture occurring, if motion of the limb be permitted before a sufficient quantity of matter has been effused, before nature has had sufficient time for the consolidation of her substitute, and consequently before the new bone has come to resemble the old in thickness and cohesion. ”