FIG. 303.-Fracture box for fracture of the leg with pillow and pad under the heel and foot. (From Da Costa's Surgery. Courtesy W. B. Saunders Co.) FIG. 306.-Dressing for Pott's fracture. (Fracture of the fibula near ankle joint.) Note the length of splints, straps, and amount of padding. (From Scudder's Fractures. Courtesy W. B. Saunders Co.) which extends from above the knee to well above the heel. The method of applying this splint and the padding is best understood from examining figures 306 and 307. Note carefully that it is necessary to turn the foot strongly in by bandages or appropriate strips of muslin (fig. 307). The splint should be worn for five weeks and then the patient may be allowed to walk on crutches for a week, using a cane after that. FRACTURES OF THE BONES OF THE FOOT. These are usually due to direct force and are often compound. Symptoms.-There is a great pain in the foot on attempts to walk and crepitus may be produced on gently manipulating the injured bone. First-aid treatment.-The other bones act as splints and usually nothing will be required except to lay the foot on a pillow. After treatment.-Put the patient in bed, apply cold compresses for several days to reduce swelling. Then reduce any obvious deformity and apply a splint of thin wood or heavy pasteboard to the bottom of the foot. The sole of the shoe is used as a pattern in cutting out the splint. Pad it and bandage in position, leaving the toes out in order to observe the circulation. The dressing should be worn for four weeks. FRACTURES OF THE TOES. First-aid treatment.-A light splint may be applied to the sole of the foot, but usually no splint will be necessary. After treatment. The injured toe may be bandaged to the adjoining toe or a light splint may be applied which covers the entire sole. The dressing should be worn for three weeks, during which time the patient does not walk on the affected foot. COMPOUND FRACTURES. Compound fractures have already been described as fractures which are complicated by wound extending down to the broken bones. It is possible to break a bone and receive a wound of the skin or a wound in some other part of the limb, but if the wound does not communicate with the fracture it is not a compound fracture. Symptoms. The symptoms are the same as those of any other fracture, with the addition of the wound (fig. 308). In severe cases the end of the broken bone may come through the wound and project on the outside. First-aid treatment.-The great aim of the treatment of compound fractures is to prevent bacteria getting into the wound. If pus germs gain admission there will be a great deal of swelling and inflamma 129054-19 -22 tion and finally suppuration. The healing of the fracture will be prolonged for many weeks and sometimes there is so much destruction of the bone by inflammatory processes that healing does not take place at all until surgical measures are employed. Therefore, in a compound fracture, always cover the wound with a sterile dressing at the earliest possible moment. After the wound has been covered, splints may be applied as in the manner already described. In case a sterile dressing is not available, the wound should be allowed to remain exposed to the air while one is being prepared. A suitable dressing made of muslin or toweling may be folded into shape and boiled, as described on page 186. After this dressing has been placed on the wound and fastened in place then apply the splints. If one of the bones is sticking out through the flesh, the question arises as to whether it is wise to attempt to restore it to its natural place. If a doctor can be obtained in a short time, make no such effort, but apply the dressing over the open wound and prevent further motion of the fragments as well as may be with the splints. If the patient will have to be transported for a considerable distance before he can reach medical help, it may be proper to attempt to replace the bone by pulling on lower end of the limb in the direction of its long axis. Before doing this, in all cases the wound and the protruding end of the bone should be thoroughly painted with tincture of iodine and all visible dirt removed from the bone, so as to lessen as much as possible the danger of dragging live bacteria into the deeper tissues. If tincture of iodine is not available, do not attempt to replace the protruding fragments. After treatment.-The after treatment of a compound fracture consists in removing the temporary splints and dressings and endeavoring to free the wound from germs by swabbing it with onehalf strength tincture of iodine very thoroughly and with great care, working the iodine into all parts of the wound. The operator should especially prepare his hands before undertaking this task, and every precaution should be taken against accidentally contaminating the wound while it is being cleaned or dressed. If the bones are protruding, they must be very thoroughly treated with iodine before efforts are made to replace them in their proper position. If particles of dirt can be seen either in the wound or on the bone, they must be removed preferably by rubbing them off either with the swab or small rolls of sterile gauze. After the wound and a wide area of the surrounding skin has been painstakingly treated with the iodine as above described the bone should be set and the wound dressed with sterile gauze. When the wound has been securely covered, proper splints are applied, but leaving them open in such a way that it is possible to re-dress the wound without dis |