Splint bone

“ This is to be done by first pulling the two portions of the bone in opposite directions, until the limb becomes as long as the opposite one, and then by applying a splint, and binding it to the part by means of a roller. When there is no deformity, the pulling is of course unnecessary. If there is much swelling about the broken part, a cold lotion is to be applied. ”

“ Finally, pass a wide band of cloth about the body, from armpit to hips, inclosing the upper part of the well-padded splint, and fasten it snugly. The hollow between splint and waist must be filled with padding before this wide cloth is applied.
In fracture of the thigh bone (between the hip and knee) , there is often great swelling about the break. The limb is helpless and useless. ”

“ For the thigh, the splints should extend from under the arm to the ankle and should be bound to the body and leg with long towels or sheets torn into strips. A splint made of blankets, rolled up tightly from both sides on broomsticks, allowing space for the limb to rest between the supports, is a good and ready appliance. Always make extension to prevent contractions of the muscles, as this would result in shortening the leg.
For a broken clavicle (collar-bone) bind the arm to the chest. Put the patient on the flat of his back with a small pad between the shoulder-blades. ”

“ Beginning with diseases of the bones as a common source of lameness, the ‘splint’ (q.v.) will be found to be of the commonest occurrence. Indeed, a horse which does not possess one or more belongs to a very small minority. The splint is a bony enlargement on the cannon-bone, between the knee or hock and the fetlock joint. ”

“ As a rule, it is also advisable to fix with the splint the joint above or below the fracture. In cases in which a splintering of the bone into a joint has taken place, more especially in those cases in which tendons have been injured, there may be a good deal of effusion into the joint and the tendon sheaths, and this may be organized into fibrous tissue leading to permanent stiffness. This is particularly apt to occur in old people. Care must be taken in such instances by gentle exercises, and by passive movement during the process of cure, to keep the joint and tendons free. ”

“ To take a common example,—in fracture close to the wrist joint, it is necessary to arrange the splint so that the patient can move his fingers and thumb, and the splint must be taken off every day, in order that the wrist and fingers may be gently bent, straightened and exercised. ”

“ The assistant keep extension while the surgeon lifts the softened gutta-percha with the towel from the hot and plunges it a moment into cold water, then lays it on the limb, which the assistant keeps at a right angle, and the bone in place, while the splint is setting to the limb. This done, the splint is removed to be trimmed, perforated, and covered with wash-leather. It is then ready for use.
Fig. 34.—Gutta-percha Splint for fracture at the lower end of Humerus.
Leather takes so much time to set that it should not be used in recent fractures. ”

“ If the treatment recommended for delayed union fails, recourse must be had to operation, the most satisfactory procedure being to insert a bone graft in the form of an intra-medullary splint. In certain cases met with in the bones of the leg in children, the degree of atrophy of the bones is such that it has been found necessary to amputate after repeated attempts to obtain union by operative measures have failed. ”

“ Then a person must wear a splint and bandage to keep the bones in place until they grow together again. The living cells will mend a bone in about a month.
An old person's bones are more tender than a child's, and will not spring much without breaking. An old man is afraid of falling and breaking his bones, while a child falls a dozen times a day without danger.
The bones of some children bend too easily. When they stand, the bones of their legs bend a little. After a while they grow in the crooked shape, and the child is bow-legged. ”

“ Two pasteboard splints, softened in hot water, and padded with tow, are applied, one on each aspect, from a little above the elbow to over the fingers; the outer should extend to the tips of the fingers, the inner need not pass the palm; they are retained by a roller. In fracture of both bones, a wooden splint should be retained on the outside of the limb for a few hours ”

“ When splinters, displaced in different directions, whether adhering to the bone or not, irritate the soft parts, and, having passed through the integuments, appear without, most practitioners advise to remove them and cut off such parts as project beyond the fractured end of the bone, previously to reduction. ”

“ The sound bone above the fracture has become more solid; the splinters not having been removed are lying across, and prevent the approximation or union of the ends of the old bone, while the effort made by nature to effect this object by the deposition of new ossific matter, adds to the evil by fixing these splinters in so solid a manner that they cannot escape or be removed by any other means than that of forcible abstraction, after painful and perhaps dangerous operations, each splinter possibly requiring a separate one. ”

“ The pieces which compose it are, 1st, A common junk-cloth25 (FFF plate II.) , accommodated to the size of the limb and the splints: 2dly, a bandage for the body (BB) and one passing under the thigh (H) to secure the first on the side opposite to the fracture: 3dly, three stiff splints, an inch and a half wide, the external one of which (AA) being very strong, must be long enough to extend from the spine of the ileum, to the distance of four inches below the sole of the foot. This splint is hollowed out or notched at its lower end, and has a mortise in it a little higher up. ”

“ After a time, flexion can be made to a right angle; and the limb becomes tolerably useful. By unsuccessful attempts to restore the natural position, inflammation is excited; and thus the salutary processes, commenced by nature for reparation of the displacement, are interrupted and delayed; in young persons such disease of the joint may be produced as might lead to loss of the extremity.
Luxation of the Radius alone, backwards on the outer condyle, is sometimes met with; but this bone is seldom singly displaced far from its original site. ”

“ In one instance, I had put up a fracture of the thigh with a long splint, and in three weeks afterwards the humerus was broken over the end of the splint during an attempt by the patient at change of posture. In many such cases union either does not take place, or is very imperfect.
In children, the bones frequently contain little earthy matter, bend easily, and often break partially on the convexity of the curve. Even at the age of twelve or thirteen, bending of the bones from injury sometimes occur to a great extent, as of the forearm from a fall on the palm of the hand ”

“ Splints can be made of anything that is stiff and rigid. Something flat like a board is better than a pole or staff; limbs broken off a tree will do if nothing else can be found. Shingles make excellent splints. In applying splints remember that they should extend beyond the next joint above and the next joint below; otherwise, movements of the joint will cause movement at the broken point. With a fracture of the thigh, such as that described, the outer splint should be a very long one, extending below the feet from the arm pit. ”

“ A general anæsthetic is necessary to ensure accurate reduction, and extension must be applied to maintain the fragments in apposition and prevent shortening. The splint which has been found most generally useful is the Thomas' knee splint, the ring of which rests against the ischial tuberosity. To admit of flexion at the knee the Thomas' splint should have a hinged attachment on which the leg is supported. This leaves the knee free and allows of movement being made to prevent stiffness. ”

“ When the patient can be put immediately to bed after the injury, and does not have to be transported, it is only necessary to apply the outer, back, and front splints, omitting the inner splint. It is necessary for the proper and permanent setting of a fractured thigh that a surgeon give an anæsthetic and apply the splints while the muscles are completely relaxed. ”

“ If the fracture is recent, and no union has taken place, a long splint should be put on outside the case, fastened to the foot and extended by a perineal band, while the starch is drying, that the limb may not shorten. With children it is best to apply the wooden splint in all cases, as they are apt to wriggle about, or sit up in bed and disarrange the case while it is in a pliant condition. If the wood splint is not used, the limb should be supported in a good position by sand-bags laid along its sides. ”

“ As there is no tendency to re-displacement and no risk of non-union, no retentive apparatus is required, but, if it adds to the patient's sense of security, a bandage or a poroplastic wristlet may be applied. In severe cases, however, anterior and posterior splints, similar to those used for fracture of both bones of the forearm, or a dorsal splint padded so as to flex the wrist to an angle of 45°, but somewhat narrower, may be employed. The hand and forearm are in any case supported in a sling. ”

“ A horse often becomes lame when throwing out a splent; but that state of the bone which causes the lameness seldom continues long; nor does it ever produce permanent lameness. If any remedy is applied, a blister is always sufficiently strong. A new method of treating splents has been lately introduced; that is, passing a seton under the skin and immediately over the splent. It is said to be an improvement. I once tried it in a case of old bone spavin, but it did no good; nor did firing, which was tried soon after, though the hot iron was passed through the skin, and into the bony excrescence. ”

“ In ordinary cases the limb is kept on the splint three weeks, until the irritation has subsided, and partial union is attained; the splint may then be replaced by a starch bandage, and the patient may leave his bed.
Transverse Fracture of the tibia alone, or even of both bones, when the displacement is small, is very well treated by a hollow splint on each side. Both splints are cut away opposite the malleoli, and the foot-piece of the inside one should not extend beyond the tarsus; that of the outside passes to the toes. ”

“ If the bone is not diseased, but is denuded of flesh all around, it is to be sawn in the same manner, for bones which are disengaged from the other parts all around cannot possibly incarnate. In like manner, the extremity of a bone near a joint, if diseased, is to be sawn off; and often, if the whole of a bone, such as the ulna, radius, tibia, or the like, be diseased, it is to be taken out entire. But if the head of the thigh-bone, or pelvis, or a vertebra of the spine be diseased, we must not attempt to operate upon them for fear of the adjoining arteries. ”

“ In adolescents and adults the limbs seldom become affected; the bones composing the spinal column are the seat of the disease, and, along with the distortion of the spine, the position of the ribs is necessarily altered. Certain rare cases have occurred, in which all the bones of the adult were softened to a very great degree. In one remarkable instance, the patient complained of an annoying sense of tightness in the limb most affected, and, on examination, the softened bone was found greatly depressed at that point, as if a strong ligature had been drawn tightly round it. ”

“ The limb is often enormously swollen and indurated. The gelatinous effusion beneath the periosteum speedily becomes organised, nodules of osseous matter project into it, and adhere to the surface of the bone frequently by a narrow neck; these increase in number, gradually assume a solid appearance: the bone is thus thickened, often to a very great extent. ”

“ 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. ”

“ When a ball merely grazes a bone without breaking it, and passes through the limb, and no splinters can be felt by the finger, dilatation is unnecessary in the first instance; although some small splinters may be cast off subsequently, or a layer of bone may exfoliate, requiring assistance for their removal. ”

“ In the shafts of the long bones, owing to the excessive absorption of bone, the cortex becomes porous, the spongy bone is rarefied, and the bones readily bend or break under mechanical influences. When the disease is arrested, a process of repair sets in which often results in the bones becoming denser and heavier than normal. In the flat bones of the skull, the absorption may result in the entire disappearance of areas of bone, leaving a membrane which dimples like thin cardboard under the pressure of the finger—a condition known as craniotabes. ”

“ As regards treatment, a tightly fitting steel cage-like splint, which, gripping the thigh and leg, limits the movements of the knee to flexion and extension, may prove useful. But for a muscular, athletic individual the wearing of this apparatus may prove vexatious and disappointing. The only alternative is to open the joint and remove the loose cartilage. The cartilage may be found on operation to be split, torn or crumpled, and lying right across between the joint-surfaces of the bones, from which nothing but an operation could possibly have removed it. ”