If three splints are placed in position before the straps are tightened the whole appliance will be rendered much more rigid. These splints should be of light wood three and a half to four inches in width and should be placed between the straps and the pillow, one on either side and posteriorly. The pillow splint and fracture-box are as good as any and can be improvised even under unfavorable surroundings. The Cabot posterior wire splint and side splints are a favorite method with some surgeons. The fragments should be brought into alignment with the least possible manipulation as the leg is being placed on the temporary splint. Oblique and spiral fractures are common in the shaft of the tibia and it may be necessary to control the overriding deformity during this time, especially if the pointed end of one of the fragments threatens to perforate the skin, as is not infrequently the case. Under these circumstances an extension apparatus should be applied to the foot. This is often a difficult matter if the materials used are the same as those employed in Buck's extension, in fractures of the hip. Adhesive plaster when applied to the foot and ankle is likely to irritate the skin, because of the small area to which it can be attached. The author has found the following method very satisfactory in instances in which extension was found necessary. The patient’s shoe is cut so that the 'upper' is divided from the sole. Slits are then cut in the sides of the 'upper' and adhesive straps passed through them to be carried below the foot to a spreader, the same as employed in Buck's extension. The upper is then placed on the foot, the lacings tightened and a weight attached to the cord after it has been passed through a pulley secured to the foot of the bed. Six, eight or ten pounds will usually suffice in correcting the deformity but the amount of weight employed should be governed entirely by the degree of muscular spasm to be overcome. Extension can be exerted in this way without irritating the foot and ankle during the time it is fixed on the temporary splint; counter-extension is had by raising the lower extremity on an incline plane or by raising the foot of the bed. Instead of splints, sand bags may be placed on either side of the leg and will serve the purpose well in steadying the parts. It is often impossible to forecast the degree of traumatic reaction which will follow in a given case and it is therefore best to postpone the application of a permanent splint until this reaction has passed.
<Callout type="important" title="Critical Alignment">Proper alignment of bone fragments during initial treatment is crucial to prevent further injury or complications.</Callout> The tension produced by the swelling, the internal laceration of soft tissues by the fragments at the time of injury, and the not infrequent venous thrombosis about the site of the fracture are conditions tending to impede circulation and demand dressings which do not constrict the leg. The plaster cast has been extensively used in the early treatment of fractures of the leg and good results have attended its use, yet the author feels that it is an unsafe appliance and is inferior in every way to the plaster stirrup or plaster splints. With either plaster splints or the plaster stirrup the dressings may be tightened or loosened as the occasion demands and during the entire course of the case a strip of skin, extending the length of the leg, is open to inspection.
<Callout type="risk" title="Risk of Infection">Immediate reduction of compound fractures can lead to severe infection if not performed under sterile conditions.</Callout> The treatment of compound fractures of the bones of the leg is essentially operative, at the present time, and with the vastly better results obtained in this way, there can be nothing but censure for non-operative methods, provided there are no constitutional contraindications and surgical facilities are available. Operative Treatment. — There are four sets of circumstances which commonly call for operative treatment. First, to accomplish and maintain reduction in recent cases in which non-operative methods have failed; second, in the treatment of compound fractures; third, when non-union is present, and fourth, for the correction of old fracture deformities.
Key Takeaways
- Use light wooden splints to stabilize fractures before applying straps.
- Cabot posterior wire splints and side splints are effective for leg fractures.
- Postpone permanent splint application until the traumatic reaction has subsided.
Practical Tips
- Cut slits in a shoe's upper to create an extension apparatus using adhesive straps.
- Use sandbags on either side of the injured leg to stabilize it effectively.
- Apply gentle traction and counter-extension techniques for better alignment.
Warnings & Risks
- Avoid immediate reduction of compound fractures without sterile conditions.
- Do not use plaster casts as they can impede circulation and are less effective than stirrups or splints.
Modern Application
While the methods described in this chapter remain foundational, modern advancements such as improved surgical techniques and materials have significantly enhanced fracture treatment outcomes. However, understanding these historical approaches is crucial for emergency situations where advanced medical facilities may not be immediately available.
Frequently Asked Questions
Q: What are some effective splinting techniques mentioned?
The chapter mentions using light wooden splints placed between straps and a pillow, Cabot posterior wire splints, and side splints for stabilizing leg fractures.
Q: Why should the application of permanent splints be delayed?
Permanent splinting should be postponed until after the traumatic reaction has subsided to avoid constriction and impeding circulation due to swelling and laceration of soft tissues.
Q: What is a recommended method for achieving extension in fractures?
A shoe with its upper divided from the sole can have adhesive straps passed through slits cut into it, attached to a spreader and pulley system to exert controlled traction on the foot.