Plastic apparatus in surgery : with especial reference to that variety made with plaster of Paris / by Samuel B. St. John.

  • St. John, Samuel B., 1813-1876.
Date:
1872
Catalogue details

Licence: Public Domain Mark

Credit: Plastic apparatus in surgery : with especial reference to that variety made with plaster of Paris / by Samuel B. St. John. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    best instrument to use in opening the splint, and the risk of cutting the patient may be reduced to a minimum by making two sections an inch apart, one on either side of the median line nearly through the plaster, and then raising the intervening piece at the top and completing the section by alternate nicks on either side. By thus removing a strip one inch wide a firm hold may be secured of the cut edge of the splint so as to spring it open to inspect the limb, and it also affords an opportunity of tightening the apparatus, should it have become loose by subsidence of swelling. Should the swelling, however, have gone down so much that it is necessary to remove a strip more than an inch wide in order to make it hug the limb, it will be better to remove the splints and make a new one, otherwise the tendency will be to roll the bones in toward the median line of the limb, in the case of the leg or forearm especially. 1 have tried various kinds of cutting pliers, Henry’s, Seutin’s, etc., and saws, also, but found none so serviceable as the knife. An instrument made by Leiter, of Vienna, a gentleman thoroughly versed in the management of gypsum apparatus assures me leaves nothing to be desired in this direction. Its mechanism is such that a tremendous leverage is obtained, so that when the lower blade is slipped between the splint and skin, the upper one cuts down upon it through the splint. The instrument has just beep introduced into this country, and promises well, but I desire nothing better than a sharp knife. In compound fractures the method of its application varies. If the opening through the soft parts is not large, and there is not much contu- sion or laceration, an apparatus like that for simple fracture may be applied, and a fenestra cut, through which to dress the wound. It must be made heavier and stronger than if the fracture were simple, but as the patient is to remain in bed with the limb supported for several days, if not; weeks, this is not a disadvantage. In several such cases I found that five bandages were usually needed, and the splint was, in all cases of fracture of the leg, extended above the knee. The fenestra should be cut in ac- cordance with the principles given in describing the longitudinal section of a splint for simple fracture. Some make a practice of leaving the piece covering the wound attached by one side like a trap-door, but in my opin- ion, it is neater to remove it entirely, as it enables the surgeon to trim the edges of the trap all around in a uniform manner, and moreover, the trap- door is apt to be in the way when the wound is being dressed. This method of procedure is, however, applicable only when the trap is to be of moderate size, of a breadth, perhaps, one-fourth of the circumference of the limb. The length of the trap is nearly immaterial, as it does not materially diminish the supporting power of the splint. When, from any cause, such as the extent of the external wound, or the suspicious look of the soft parts (and this applies equally to simple fractures with great con- tusion) it becomes necessary to have a large surface accessible to inspection without disturbing the fragments—a combination of the plaster bandage with blanket soaked in gypsum “cream” is to be used—and it was this