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Results of Fractures.The first danger to be apprehended is, of course, loss of life. This danger is much greater in people of feeble constitutions and impaired health, though the fatal result may occur even in robust individuals The danger to life is much greater when there is a wound communicating with the break in the bone - that is, in compound fractures. Fractures are more dangerous in the lower extremities than in the upper, and most dangerous when located between the hip and the knee. There is, furthermore, some chance that the bones will not unite. This is a rare incident, more frequent in old persons than in others. There are certain parts of the body, fractures of which are more apt to be followed by trouble of this kind than others. Thus, fractures of the kneepan and of the upper end of the thighbone occasionally fail to unite. In these cases the ends of the broken bone are bound together by a membranous material, forming a so-called false joint. This may in time become quite manageable, and give the patient but little annoyance. In other instances the limb remains practically useless in consequence. There are certain operations known to surgeons whereby the healing of the broken ends can be furthered if they show signs of refusing to unite. A most common result of fracture is permanent shortening of the limb. This is especially apt to occur in fractures of the leg and of the thigh. In fact, fractures of the thigh are, for practical purposes, sure to result in shortening of the leg. In many cases this shortening is inconsiderable, and does not materially impede the patient's movements nor detract from his comfort. If the limb be only half an inch to an inch shorter than its fellow, the patient will rarely experience any difficulty. This fact can be better comprehended when we remember that there is a difference of nearly half an inch between the length of the two legs in the average healthy person who has never suffered a fracture. If, however, the fracture result in the shortening of the limb, amounting to one and a half or two inches, the patient may be compelled to wear a shoe with an extra high heel. The important point for the public to remember is, that such a shortening may result in the very best surgical hands, and that it is not, therefore, necessarily evidence of any lack of skill. Such a shortening is especially apt to occur in a robust and muscular individual. Another feature to be borne in mind is that a limb which is just as long as the other one when removed from its splint, may become shorter in the course of a month or two. This seems to result from the fact that the new bone formed at the seat of the fracture is so soft that it gives way when the weight of the body is brought upon it in the patient's efforts to walk. In many cases a deformity results inevitably from fracture. Such deformity may, of course, be the result of improper treatment ; the bone may not have been properly set, or even if originally set in the proper way, the dressing may have become loose, so that the broken ends of the bone have been pulled out of their proper position by the action of the muscles, and the bone has healed in this unnatural position. Yet there are instances in which it is an utter impossibility to keep the broken ends in proper position during the healing of the fracture. One of the most common places for these intractable fractures is the collar-bone. It is well known to surgeons that more or less deformity is the rule after the fracture of the collar-bone, notwithstanding all the efforts of the most skillful surgeon to prevent it. Another fracture which is apt to be followed by deformity is the one which so frequently happens when people in falling put out the hand to break the fall. This often results in a fracture of one of the bones of the forearm just above the wrist, technically known as Colles' fracture. The deformity which so often results from this fracture has led to innumerable suits for malpractice against surgeons. Patients might save many lawyer's fees by remembering the fact that it can be proven in court, by the testimony of the entire medical profession if necessary, that this fracture is in many cases inevitably followed by deformity, and that a deformity is not, therefore, sufficient evidence of lack of skill on the part of the surgeon. Another accident which sometimes results in fracture is stiffness of the limb. It is a fact that simple disuse of a joint for several weeks is, in most cases, sufficient to cause stiffness of the joint. This stiffness may gradually disappear if persistent and systematic efforts are made to bend the limb ; in some instances, on the other hand, the stiffness is permanent. Such a loss of motion is especially apt to occur if the fracture has been located near a joint, so that the dressing has necessarily prevented movement of the joint during the healing of a fracture. Yet it may happen when the injury is located somewhat remotely from a joint. In fractures of the thigh there remains almost invariably some stiffness of the knee as well as of the hip. When the patient first rises from his bed he may be quite unable to bend the knee. This stiffness, however, usually passes off in the course of a few weeks or months. All these accidents may occur as a result of simple fracture - that is, fractures in which the bone is broken without any wound of the skin communicating with the break. If the latter feature be also present - that is, if the fracture be compound-the probabilities of disastrous results are much increased. This fact results from several causes : first, because an injury which results in a compound fracture is often more extensive and severe; and, second, because the presence of the wound interferes in many cases with the application of dressings, so that it is impossible to employ the appliances necessary to keep the broken ends in their proper position. There are certain complications which may follow any fracture, but are almost invariably met with in connection with compound fractures, that is those in which the skin is wounded over the break in the bone. It is especially important, therefore, that compound fractures be carefully watched. In treating such a fracture it is important that we do everything possible to promote the discharge of matter which may form in the wound. The retention of this matter may result in an infection of the body, which often terminates fatally, and is known under the name oi pyæmia, or blood-poisoning. We should, therefore, in every case of compound fracture see that a free opening is made for the discharges. It has been already stated that, in treating such a fracture, a hole should be cut in the dressing over the wound ; and it is also necessary that the wound be syringed out two or three times a day with an antiseptic solution. For this purpose we may keep on hand one of the following liquids : Carbolic acid, - - - Half an ounce. Water, "- - - One pint. Instead of this, it will be better to employ the following solution : Listerine, - Two ounces. Water, ------ Eight ounces. After syringing the wound thoroughly with one of these liquids, it may be dressed by laying upon it a piece of lint or soft cloth spread with vaseline. If the wound be extensive and the bone be badly crushed, it is often necessary to amputate the member. The services of the surgeon are, of course, in this case indispensable. In some such cases surgeons are enabled to save the limb by immersing it in warm water, into which a little carbolic acid (about 2 per cent.) has been poured. For this purpose a trough of tin or zinc is made so as to contain the water and to hold the limb comfortably. The injured member is permitted to remain in this trough for a week or two, or until the severity of the inflammation has disappeared. In such cases it is, of course, impossible to keep any dressings applied for the purpose of retaining the limb in position. In fact, in such instances the question is not whether the patient shall have a perfect limb without deformity or shortening, but simply whether he shall have any limb at all. The treatment of compound fracture usually includes also the use of opiates to quiet pain. For the first two or three days it may be necessary to give an eighth of a grain of morphine every five or six hours. The patient will also usually have considerable fever during the first week after the injury. This should be treated by the use of Rochelle salts in sufficient quantity to secure free movement of the bowels at least once a day. It may be advisable also, in case the fever is high, to sponge the patient twice a day with warm water and to give him the following prescription : Quinine, - - - Twenty-four grains. White sugar, - One drachm. Mix and make twelve powders. Take one every four hours. His fever will be allayed to a certain extent by the following mixture: Acetate of potash, - Five drachms. Sweet spirits of niter, - Two ounces. Water, ------ Two ounces. Mix and take a teaspoonful four times a day. If there be unusual redness around the wound, and especially if the skin show signs of a black discoloration, the injured member should be immersed for a few hours every day in hot water to which a little carbolic acid has been added, and the portion of the skin which has become dark should be cut off; for this discoloration is due to death or gangrene of the tissue, and if it be not cut off it will finally be separated by the formation of matter, after the patient has experienced much annoyance and some danger from it. The chief danger to be apprehended in these cases of compound fracture is Blood Poisoning-Pyæmia. But first, if you want to come back to this web site again, just add it to your bookmarks or favorites now! Then you'll find it easy! Also, please consider sharing our helpful website with your online friends.
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