Part 26
As a general rule it may be said, that in those cases in which a separation
of bone is not expected, the same treatment should be applied as when
the fractures are not complicated with an external wound; for the
extension, adjustment of the bones, and the bandaging, are to be conducted
in the same manner. To the wound itself a cerate mixed with pitch
is to be applied, a thin folded compress is to be bound upon it, and
the parts around are to be anointed with white cerate. The cloths
for bandages and the other things should be torn broader than in cases
in which there is no wound, and the first turn of the bandage should
be a good deal broader than the wound. For a narrower bandage than
the wound binds the wound like a girdle, which is not proper, or the
first turn should comprehend the whole wound, and the bandaging should
extend beyond it on both sides. The bandage then should be put on
in the direction of the wound, and should be not quite so tight as
when there is no wound, but the bandage should be otherwise applied
in the manner described above. The bandages should be of a soft consistence,
and more especially so in such cases than in those not complicated
with a wound. The number of bandages should not
[p. 194] be smaller, but rather
greater than those formerly described. When applied, the patient should
have the feeling of the parts being properly secured, but not too
tight, and in particular he should be able to say that they are firm
about the wound. And the intervals of time during which the parts
seem to be properly adjusted, and those in which they get loose, should
be the same as those formerly described. The bandages should be renewed
on the third day, and the after treatment conducted in the same manner
as formerly described, except that in the latter case the compression
should be somewhat less than in the former. And if matters go on properly,
the parts about the wound should be found at every dressing always
more and more free of swelling, and the swelling should have subsided
on the whole part comprehended by the bandages. And the suppurations
will take place more speedily than in the case of wounds treated otherwise;
and the pieces of flesh in the wound which have become black and dead,
will sooner separate and fall off under this plan of treatment than
any other, and the sore will come more quickly to cicatrization when
thus treated than otherwise. The reason of all this is, that the parts
in which the wound is situated, and the surrounding parts, are kept
free of swelling. In all other respects the treatment is to be conducted
as in cases of fracture without a wound of the integuments. Splints
should not be applied. On this account the bandages should be more
numerous than in the former case, both because they must be put on
less tight, and because the splints are later of being applied. But
if you do apply the splints, they should not be applied along the
wound, and they are to be put on in a loose manner, especial care
being taken that there may be no great compression from the splints.
This direction has been formerly given. And the diet should be more
restricted, and for a longer period, in those cases in which there
is a wound at the commencement, and when the bones protrude through
the skin; and, in a word, the greater the wound, the more severe and
protracted should the regimen be.