Treatment of Compound Fractures
Treatment of Compound Fractures
The treatment of compound fractures is one that requires some "nerve" on the part of the acting surgeon and a great deal of fortitude in the injured person. A compound fracture of the leg or thigh is the most terrible accident, short of death, that can befall a man in the woods. Unless great care is exercised the man will die, either shortly from septic poisoning, or almost immediately from shock.
First, get your patient into camp if he is away from it. That may be done in the following manner, which will also illustrate how to carry a person injured in any man* ner: take a blanket and lay it at full length on the ground; place a pole two feet longer than the blanket directly in the center and fold the blanket over it; lay a similar pole in the center of the folded half and fold the free side back over; place your patient on top, and two men can carry him as comfortably as though he were in a litter. It is, in fact, an emergency litter.
Another emergency litter may be constructed by buttoning an overcoat its full length and running two poles down the sides, laying the patient between them. Failing an overcoat, two short coats or Mackinaw jackets may be made to serve.
Having got your patient with the compound fracture into camp, cut off all clothing from the wounded limb, but no more. It is a bad plan to remove too much clothing from badly injured persons. All the warmth must be conserved, even to the extent of applying artificial heat. Examine the wound for foreign matter and carefully remove it, especially bits of clothing, leaves, small sticks, and bits of earth.
While you have been thus engaged, water should be heated in the cleanest, brightest vessel the camp affords. If there are none bright enough, one may be sterilized by burning it over a hot fire for at least ten minutes. It is absolutely essential that the water used to cleanse a wound of this character should be sterile—that is, without any germ life whatever; hence the directions for boiling it.
In another clean vessel boil all the cloths, towels, and other dressings that you intend using. Any soft cloth will do for dressings, provided it is sterilized and sterilization consists only in thorough boiling.
One of the articles I shall mention in a very limited surgical kit is a bottle of tablets composed of bi-chloride of mercury known as Bernay's tablets. They are made by all chemical houses and vary in form, but all contain about the same quantity of the antiseptic agent. Some are white and some blue in color, the blue being preferable.
One of these tablets dissolved in a quart of water makes a solution of about the proper strength for dressing wounds. Make your solution and with your sterilized cloths wash out the wound thoroughly, and that does not mean to let a little water flow over the wound; it means to remove every particle of foreign matter in and about the wound.
If the bones have stuck into the earth, as is quite often the case, they must be exposed and the narrow canal cleaned. Then replace the bones in as nearly their proper position as possible. Do not attempt to "set" the bone; just put it back fairly nearly in line. Then cover with several layers of moist cloth that have been previously boiled and dipped in the bi-chloride solution.
Every day expose the wound, wash it out, and dress it. If the patient is of strong physique and God smiles, he may not have septic fever. If, however, the limb shows signs of inflammation evidenced by swelling and redness, accompanied by fever, chills, and thirst, then must you perform some heroic tasks to save your patient's life.
Remove all dressings and wrap in perfectly clean dressings the entire limb from the hip to the foot, elevate so that it will drain properly, and keep cold water running over it in a small stream constantly. This may be done by making a small hole in the side or the bottom of a bucket and hanging it in such a way that it will permit the stream to fall on the limb. If you follow the foregoing directions implicitly, you have done all that can be done.
It will be understood that what I have said touches upon the subject of fractures in only a very general way. The methods of treatment outlined will apply to practically any fracture, and certainly to those most liable to be encountered in the woods.
Moody, Charles Stuart. Backwoods Surgery & Medicine. New York: Outing Pub., 1916. Print.
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