. A practical treatise on fractures and dislocations. olution; loose fragments arcremoved, the ends of the bones regularized if necessary, and the deeperlayers of muscle and fascia fastened together by sutures so as to givesupport to the fragments; if deemed necessary a catgut or temporarysuture may be placed in the bone to hold the fragments the enveloping fascia is sutured at a few points, not too closely,and the skin sutured so far as its condition permits. Drains of rubberor gauze are inserted, and a dressing placed over all. The limb isthen placed in splints that will permit
. A practical treatise on fractures and dislocations. olution; loose fragments arcremoved, the ends of the bones regularized if necessary, and the deeperlayers of muscle and fascia fastened together by sutures so as to givesupport to the fragments; if deemed necessary a catgut or temporarysuture may be placed in the bone to hold the fragments the enveloping fascia is sutured at a few points, not too closely,and the skin sutured so far as its condition permits. Drains of rubberor gauze are inserted, and a dressing placed over all. The limb isthen placed in splints that will permit a change of dressing with theleast disturbance of the fragments; for the leg Volkmanns splint isconvenient, or the plaster stocking (page 93), or moulded anteriorand posterior splints, one of which is placed if possible next the skinand protected by rubber tissue or Cronxs paste (p. 95) from soaking bythe discharge (Fig. 50). Later in the course, if the case does well, aninterrupted or fenestrated splint may be used, but the dressing oceu- Fig. Compound fracture. Dressing and plaster splint. pying the fenestra or interval must be bound on very snugly or thetissues under it will become eedematous and project through the open-ing. Suspension adds to the comfort of the patient and often to theconvenience of the surgeon. For the thigh Hodgens splint is usually the most convenient, butthe double inclined plane is sometimes better. For the arm, especiallyin fractures near the elbow, I like vertical suspension; it seems to 108 FRACTURES. keep down the reaction very efficiently, but moulded splints are veryconvenient, as they also are for the forearm. The condition of the skin about the wound in these fracturesdemands close inspection, for it is usually much more seriously andextensively affected than its appearance indicates. It is almost inva-riably stripped up from the underlying parts for a considerable dis-tance and certain to slough, often over a large area, although it may
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