The Canadian nurse . -carded. The fracture site should beexposed through an incision in thelong axis of the limb, of length to en-sure easy access to the depths of In general, the length of theincision should be twice its greatestdepth. Skin edges are very viable andshould be preserved. Muscles are splitin the direction of their fibres andmajor vessels and nerves non-viable tissue should be re-moved and the depths of the woundexplored with a finger tip. Foreignbodies and free bone fragments areremoved. Bone fragments with peri-osteal attachment are preserved. Irri-gat
The Canadian nurse . -carded. The fracture site should beexposed through an incision in thelong axis of the limb, of length to en-sure easy access to the depths of In general, the length of theincision should be twice its greatestdepth. Skin edges are very viable andshould be preserved. Muscles are splitin the direction of their fibres andmajor vessels and nerves non-viable tissue should be re-moved and the depths of the woundexplored with a finger tip. Foreignbodies and free bone fragments areremoved. Bone fragments with peri-osteal attachment are preserved. Irri-gation with saline will aid in clearingthe wound by floating up small freefragments. Hemostasis should be meti-culous. When the above procedures havebeen completed, the fragments shouldbe placed in the best position mass casualties, it would be unwiseto attempt any form of internal fixationat this stage, and holding the woundopen loosely with fine dry gauze orvaseline gauze would be much safer Vol. 49. No. 9. THE TREATMENT OF FRACTURES fore infection has become established,the principles of removal of devitalizedtissue as described above would haveto be modified and the procedure wouldbe essentially establishing free drainageand removing obvious contaminantsand free fragments. If, after five or six days, the generaland local conditions are satisfactoryand the patient has reached a sitewhere adequate supervision can be as-sured, the reduction can be completedand the skin closed. Skin edges willclose as easily at five or six days as atinitial operation and the safety of thismethod is a strong recommendation inits favor. If the condition of the wound is lesssatisfactory, or there has been someinfection, it would be wisest to allowgranulation to proceed from the depthswith hopes of skin grafting or second-ary closure of the wound at a laterdate. A conservative approach to theclosing of compound wounds will likelygive the best over-all results when alimited personnel may be
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