Fracture

“ A simple fracture is where the bones are broken, but there is no external wound, and when the bones are set they heal for the most part readily. But a compound fracture is one in which the bone pushes through the skin, the muscles are lacerated, or, by the agent that breaks the bone, an external wound made, and air admitted. The laceration of the muscles and the admission of air, especially the presence of air, causes inflammation, the wound suppurates, sloughs, instead of healing, and ulceration is produced; it then becomes necessary to amputate, and the patient, being reduced, often dies. ”

“ The fracture is frequently compound; being produced by a direct blow, as the kick of a horse. The bone sometimes breaks at a part not struck, as at the symphysis from a blow near the angle. The accident is easily recognised; in fact, the patient, if sensible, has himself discovered fracture before he applies for assistance. There is distortion of the part, and the broken extremities, when moved, are felt grating on each other; there is discharge of blood, perhaps of teeth, from the mouth; and in compound fracture the ends of the bone are visible. ”

“ 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. ”

“ It is no uncommon experience to find a patient walk into hospital with an impacted fracture of the neck of the femur or a fracture of the fibula; or to be able to pronate and supinate the forearm with a greenstick fracture of the radius or a fracture of the ulna.
Pain.—Three forms of pain may be present in fractures: pain independent of movement or pressure; pain induced by movement of the limb; and pain elicited on pressure or “tenderness.” In injuries by direct violence, pain independent of movement and pressure is never diagnostic of fracture, as it may be due to bruising of soft tissues. ”

“ A fracture is said to be simple, where there is no wound of the superimposed integuments. The external parts may be bruised, or the deep structure much injured, with laceration of the vessels and rapid and great swelling; or there may be little or no injury of the soft parts. Great danger may exist without division of the integuments; these, yielding under the force, may remain entire, whilst by great and direct violence the bone is comminuted, the muscles broken up, and the vessels and nerves torn,—the limb is infiltrated with blood, and must become gangrenous as soon as reaction takes place. ”

“ I have at present in the hospital a man with severe compound fracture of both bones of the left leg, caused by direct violence, who, after the cessation of the sanibus discharge under the use of the paste, without a drop of pus appearing, has been treated for the last two weeks exactly as if the fracture was a simple one. ”

“ In injuries resulting from indirect violence, however, pain localised to a spot at some distance from the point of impact is strongly suggestive of fracture—as, for example, when a patient complains of pain over the clavicle after a fall on the hand, or over the upper end of the fibula after a twist of the ankle. Pain elicited by attempts to move the damaged part, or by applying pressure over the seat of injury, is more significant of fracture. ”

“ A number of conditions influence the ease with which a fracture is produced and account for a fracture being due to a slight injury, and so are mitigatory circumstances in the case.
Fractures are more easily produced in the old and young, especially the former, than in the adult from the same force. ”

“ Whatever may be the mode and place of the fracture, its diagnosis presents difficulties which experience and habit may doubtless overcome, but which too frequently puzzle and embarrass the most enlightened practitioner. Let us endeavour to diminish them somewhat, by tracing, in their order of succession, the symptoms which characterize the accident.
85. At the time of the fall, a sharp pain is felt; sometimes a report is plainly heard; a sudden inability to move the limb occurs; the patient cannot rise, a circumstance, however, which does not always take place. ”

“ If a wound in the soft parts accompany the fracture, whether it be produced by the same cause, or by the subsequent passage of the fragments through the integuments, and whether it communicate with the articulation or not, it is necessary, as soon as suppuration has taken place, to renew the dressings every day or every other day, taking care, in the mean time, to supply, by the hands of an assistant, the want of extension by means of the apparatus. ”

“ There are certain fallacies to be guarded against. For example, a fracture may exist and yet unnatural mobility may not be present, because the bones are impacted into one another, or because the fracture is an incomplete one. Again, the extreme tension of the swollen tissues overlying the fracture may prevent the recognition of movement between the fragments. Deformity also may be absent—as, for instance, when there is no displacement of the fragments, or when only one of two parallel bones is broken, as in the leg or forearm. ”

“ This fracture is more common in the bones of children.
Fractures may be caused by direct violence, as when a bone is broken at a certain point by some powerful force, as a blow from a baseball bat or a fall from a horse. Again, a bone may be broken by indirect violence, as when a person being about to fall, throws out his hand to save himself. ”

“ Clinical Features.—As the fracture almost invariably implicates the articular surface, there is considerable swelling from effusion of blood into the joint. The power of extending the forearm is impaired, and other symptoms of fracture are present. The amount of displacement depends upon the level of the fracture, and the extent to which the aponeurotic expansion of the triceps is torn. ”

“ What are the Signs which shew that the Splints remain in the Fracture after it hath been reduc'd?
They are the secret and continual Workings of the Fibres, or twitchings, that are felt by Intervals in the Part, with great Pains, which are the Indications of an Abcess arising therein; and when a Wound is join'd to the Fracture, the Lips of it are puff'd up, and become more soft and pale, the purulent Matter abounding also more than ordinary.
When the Splints appear, must they be drawn out by force? {191}
By no means; for great care ought to be taken to avoid all manner of violent Operations ”

“ 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. ”

“ When properly adjusted, the bone heals rapidly. Sometimes bones are crushed into a number of fragments; this is a comminuted fracture. When, besides the break, there is an opening through the soft parts and surface of the body, we have a compound fracture. ”

“ 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. ”

“ 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. ”

“ The direction of the force, too, as already observed, when on the subject of fracture, is an important assistant in diagnosis; from falls or blows upon the shoulder we may expect fracture, from falls on the elbow or palm, luxation. In dislocation an indistinct feeling, sometimes amounting to obscure crepitation, is occasionally perceived during rotation of the limb; and this arises from one or more of the tendinous attachments of the muscles having, during their disruption, torn away a portion of their osseous attachment. ”

“ 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. ”

“ 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. ”

“ One teaspoonful of salt and a half-teaspoonful of baking soda to one quart of water.
4. Do not give him alcohol.
Broken Bones
Any break in a bone is called a fracture. If you think a person may have a fracture, treat it as though it were one. Otherwise, you may cause further injury. For example, if an arm or leg is injured and bleeding, splint it as well as bandage it.
With any fracture, first look for bleeding and control it. Keep the patient comfortably warm and quiet, preferably lying down. If you have an ice bag, apply it to the fracture to ease the pain. ”

“ In this variety the degree of force which produced the fracture would not be sufficient to cause a fracture in a healthy bone.
The causes of traumatic fractures may be either predisposing or exciting.
Predisposing Causes. The bones of the human body attain their greatest strength toward middle age. From infancy up to that time the bones are very elastic and yielding. Toward old age an interstitial atrophy occurs. It causes a thinning of the cortex of the shafts and of the trabeculae of the spongy portions of the long and short bones. ”

“ A man, in the Hotel-Dieu, fractured the rotula of each knee, in the operating room, by means of convulsive motions, produced by the operation of lithotomy.
5. The action of external bodies, can alone produce a longitudinal fracture, as when a person falls on a sharp projecting piece of timber: but this may also produce a transverse fracture. On the other hand, muscular action can never give rise to any but the latter kind, since the direction of this fracture is at a right angle with that of the extensors. ”

“ They occur, in general, in two ways, being the result, sometimes of the action of external bodies, immediately applied, and at other times of the same action, operating by way of a counter-stroke. The occasional percussion of a body on the fore-arm, furnishes an example of the first mode of fracture. ”

“ A fracture is a severe malady because a condition of shock is usually present. The affected part is painful, the contour of limb is changed, a grating (crepitation) is felt and heard when the broken ends are rubbed together. ”

“ If a fracture, then, occur in the head, it is discovered by the sharpness, weight, hardness, or violent force of the body which struck it, and by the symptoms which supervene upon the person who has been struck, such as vertigo, loss of speech, and sudden prostration, more particularly if it be a fracture with depression, or contusion, or expression, or the internally-arched fracture, owing to the compression of the brain. ”

“ Fracture of the Narrow Part of the Neck or Intra-capsular Fracture.—This fracture is most frequently met with in elderly persons, especially women, and is usually produced by comparatively slight forms of indirect violence—such, for example, as result from the foot catching on the edge of a carpet, a stumble in walking, or missing a step in going downstairs. ”

“ Part XXXIX When the fracture is complicated with a wound, one need not be troubled on that account, but pitch-cerate or any of the applications for fresh wounds is to be applied to the sores; for, in general, they admit of easy cure, even when there is reason to apprehend that pieces of bone will come out. ”

“ Fracture, simple or compound, is comminuted when the bone is divided at the broken point into fragments, either small and loose, or large and adherent to the covering of the bone and other soft parts. ”

“ When the fracture takes place at one end, if at the head of the thigh, the middle part of a thong wrapped round with wool, so that it may not cut the parts there, is to be applied to the perinæum, and the ends of it brought up to the head and given to an assistant to hold, and applying a ligature below the fracture, we give the ends of it to another assistant to make extension. ”

“ The touch will always discover in what part of the bone the fracture is situated, which, if it be oblique, will partake more or less of the characters of the longitudinal or the transverse, accordingly as it approaches to the one or the other. ”

“ Besides, the history of the accident is an excellent guide towards correctly ascertaining the nature of the injury. If the patient, in falling, have involuntarily stretched out his arm, in order to save himself, and alighted with his whole weight on the palm or elbow, dislocation will most probably have occurred. If, on the contrary, he have pitched upon the shoulder, without any intermediate breaking of the fall, fracture is to be expected. ”