DESCRIPTION of a NEW-CONSTRUCT⯑ED INSTRUMENT for FRACTURED LEGS, recommended to be uſed inſtead of the common Apparatus. See the Plate.
[6]THE Figures are drawn on a Scale of three Inches to a Foot, and repre⯑ſent two Splints of ſtrong Paſteboard made with Glue, to be faſtened upon a fractured Leg, by three Straps which ſurround the whole.
Theſe are adapted to the Leg of a mid⯑dle-ſized Man: nevertheleſs it may be convenient to have two other Sizes; the one almoſt twenty-two Inches in Length, and the other ſixteen.
Fig. I. A repreſents an under Splint of an irregular Form, ſuitable to that Part of the Leg it is intended to cover; it is a little con⯑vex externally and concave internally. The Length eighteen Inches from (a) to (b). [7]The Width two Inches and three Quarters at the Strap near the Knee; and two Inches and a Quarter at both the other Straps.
B,B,B, three Leather Straps from fifteen to twenty Inches long and one wide, having two Rows of Holes ſo placed, that every Hole in each Row may be oppoſite to a Space in the other. Theſe muſt be ſewed faſt to the Middle and Outſide of the under Splint. The Portions of Straps (ddd) on the anterior Part of the Splint muſt be ſhorter than thoſe on the poſterior (eee) which are to ſurround the more muſcular Part of the Leg.
C, a Part to ſupport the Foot from the Point (a) to the Heel (c), five Inches long at an Angle of ſixty Degrees.
D, the Foot-ſtrap, twelve Inches long, ſewed to the Bottom of the under Splint, within two Inches of the Point, to paſs un⯑der the Heel and through the Leather Loop on the upper Splint, to the loweſt Pin.
E, an irregular oval Hole two Inches long and almoſt one wide in the loweſt [8]Part, but decreaſing upwards to receive the Malleolus externus, or lower Extremity of the Fibula.
Fig. II. repreſents the Leg raiſed up, to ſhew the Situation of the under Splint when properly applied.
Fig. III. repreſents a fractured Leg when laid within the Splints, according to the Method I am about to recommend, having the Stocking-Foot (or Sock) and Shoe upon it. The darkeſt Shade in this and Fig. II. being intended to ſhew that Part of the Splints within the Shoe.
Fig. IV. A, the upper Splint. B,B,B, the Pins. C, the Leather Loop to receive the Foot-Strap.
Fig. V. A many-tailed Bandage, made of Slips of Ruſſia Linen, regularly increaſ⯑ing in Length, from twelve or fourteen, to eighteen or twenty Inches, according to [9]the Size of the Leg. Each of theſe Slips (being two Inches broad) is ſo laid as to cover Half the Breadth of that which is underneath it (viz. one Inch.) Another Slip, ten or twelve Inches long, is ſewed on the Back, ſo as to unite them all in the Middle, making a Bandage equally as firm as a circular one, and which may be uſed without diſturbing the Leg. The nar⯑roweſt Part muſt be placed neareſt to the Heel. As the Number of Slips is to be increaſed or leſſened, according to the Space neceſſary to be incloſed within them, I call this a many-tailed Bandage, leaving the preciſe Number to be determined accord⯑ing to the Nature of the Circumſtances.
This has been uſed many Years in St. Bartholomew's Hoſpital, inſtead of the old eighteen-headed Bandage: Neverthe⯑leſs, as it is not generally known, I hope this Deſcription will not be thought ſuper⯑fluous.
The three different Sizes of Splints above-mentioned will generally be ſufficient; [10]at leaſt one or other of them may ſerve any Leg of an Adult till others can be provided.
The Legs of Children, as they are more round and leſs muſcular, may be defended, nearly in the ſame Manner, with the com⯑mon wooden Splints, properly bolſtered, that are now made Uſe of in St. Bartholo⯑mew's Hoſpital, provided they are long enough to ſecure both Articulations of the fractured Bones.
When a Surgeon is called to a fractured Leg, at the Place where the Accident hap⯑pened, let him lay the Patient on the in⯑jured Side, on a flat Surface, and raiſe the Knee of the fractured Limb towards the Abdomen, bending at the ſame Time the Knee-Joint, ſo as to put the Extenſor-Muſcles of the Foot (which are the ſtrong⯑eſt) into a State of Relaxation. He will then be enabled to replace the Ends of the fractured Bones, and reſtore them to their proper Situation, without the cuſtomary ſtrong Extenſion of the Limb, which is troubleſome to the Surgeon, painful to the [11]Patient, and apt to bring on Tenſion, Spaſms, and Inflammation of the ſtretched Muſcles.
When the Ends of the fractured Bone are replaced, (which may often be done even without removing the Shoe or Stock⯑ing,) let an under Splint, of the moſt ſuit⯑able Size, be applied to the Fibula, (or outſide of the Leg,) and, if it does not fit exactly, let it be made to do ſo, by adding ſuch Compreſſes of Tow, or thick Flannel,‖ as may be neceſſary for that Purpoſe.
This Poſture is much more comfortable and convenient, (rendering it leſs trouble⯑ſome for the Patient to eaſe himſelf or be moved by others,) and removes the Foot and Toes out of the Way of being hurt by the Weight of the Bed-Cloathes, ſo as to make a Fracture-Box or Cradle unneceſſary.
If the Fracture be compound, the Wound generally heals by the firſt Inten⯑tion, the great Impediment, (Irritation,) being prevented; of which I can produce many Inſtances. Add to this, that the [12]Leg may be taken up with the whole Ap⯑paratus, and the Knee-Joint gently moved as often as neceſſary, to prevent that Stiff⯑neſs which always ſucceeds a Caſe of this Kind, and is attended with much Pain and Inconvenience, a long Time after the Leg is otherwiſe well. The Patient may alſo be taken out of Bed frequently, without Pain or Danger, if not very heavy or unweildy.
The under Splint makes a ſafe and ſecure Bed for the Leg whilſt the upper Part is dreſſing, (if a compound Fracture,) and the Leg may, by a ſteady Hand, be ſup⯑ported alſo againſt the upper Splint, and put into any Poſture that may be neceſſary to dreſs a Sore on the Fibula, or under Part.
I do not always remove the Shoe and Stocking-Foot; as well becauſe they ſerve to keep the Part in Perſpiration, as that the Shoe adds Steadineſs to the Limb, by the Connection it may have with the inferior Part of the Inſtrument.
Let alſo the upper Splint be applied on the Inſide of the Leg, ſo as almoſt to cover [13]the Tibia, on its whole Length. The Straps may then be faſtened ſufficiently tight to ſecure the Whole. This done, the Patient may eaſily be removed in a Sedan Chair, (having the Cuſhion ſo raiſed that the Leg may hang down without reſting upon the Bottom,) or in a Coach, with the Limb ſupported by the Hand of a Surgeon, ſo that it may yield to every Motion uniformly, or all together, as it were, whilſt it ſwings in his Hand; for it matters not how great the Motion of the Body be, provided the Points of the fractured Bone are ſecured from being moved, the one againſt the other.
In this Manner I have carried many Pa⯑tients, from the Place of the Accident, over the London Pavements, to their own Homes, at a great Diſtance, without their having ſuffered any Inconvenience from the Motion, even when the Fractures were compound.
When the Patient is brought home and put to Bed, (the Bed having a Mattraſs [14]upon it,) let the Stocking be removed, and the proper Remedies, with the many⯑tailed Bandage and the above Splints, ap⯑plied, obſerving the ſame Directions, as to Poſture, which I have already given; viz. that the Patient be laid on his Side, with the broken Leg undermoſt, the Knee bent, and the Thigh drawn up, inſtead of laying him on his Back, with the injured Limb extended.
Both the Splints are, deſignedly, made narrow, to leave Room for Examination of the Parts affected, leſt any undue Preſſure ſhould occaſion Pain; but if it ſhould be objected that they are not ſufficiently broad for a thick Leg, that Inconvenience may be remedied by putting a Slip of Paſteboard, or thin Wood, between them, on the fore Part of the Leg, if thought neceſſary. The Straps of the Inſtrument are ſufficient to ſe⯑cure the Whole.†
[15]I made, with my own Hand, the firſt of theſe Inſtruments, of ſtrong Paſteboard, with Iron Plates rivetted upon them, which ſucceeded very well. I have tried alſo va⯑rious Materials for the ſame Purpoſe, ſuch as ſtrong‡ Hide Leather, hardened with Glew; alſo Wood, and Plate Copper; any one of which will anſwer ſufficiently, if well formed: nevertheleſs I ſhall prefer the Paſteboard, if made ſtrong enough, till I can meet with a Workman that will make them accurately of harder Materials.
[16]The ſame Poſture that is recommended for broken Legs, I have found equally ſer⯑viceable with Reſpect to broken Thighs, and for the ſame Reaſon. In which Caſe the common wooden Splint is as good as any other, provided it be long enough to ſecure both Extremities of the fractured Bone.
I have, through the Whole of this De⯑ſcription, made Uſe of the Terms upper and under Splints, for the Sake of being more eaſily underſtood; though perhaps the calling the one Tibiale, * and the other Fibularium, † would ſerve to diſtinguiſh them better, and give a more preciſe Idea of the Manner of their Application; the firſt being placed ſo as to cover a great Part of the Tibia, and the ſecond forming a ſafe Bed for the Fibula.