PLASTER OF PARIS AS AN IMMEDIATE DRESSING AFTER FRACTURE OF THE LEG.
DR. WILLIAM G. PORTER presented two boys, brought from the hospital to illustrate the application of a dressing which he had been using for a long time in the treatment of fractures of the leg. He demonstrated this dressing before the Academy a few years ago. It is a plaster-of-Paris dressing which is applied in the following way. The limb is first carefully set under ether if necessary, firmly held in position, and a flannel roller bandage carefully applied from the roots of the toes to above the knee joint about the junction of the middle and lower thirds of the thigh. A block tin tape is then placed on the front of the limb, moulded accurately to it and held in position. The plaster-of Paris bandages are then applied in the ordinary way, and are at once cut through with a sharp knife on the block tin tape as a guide, which is then removed and an ordinary muslin roller band age applied over all to secure the dressing. He had used this dressing for the last fifteen years as a routine dressing in all cases of fracture of the leg, applied at once as soon as he took charge of the case. There is no preliminary treatment by a fracture-box or any other appliance. If there are blebs, either serous or san guineous, they are evacuated and boric ointreent, or some similar application, used. If the case is seen early and the dressing is promptly applied, there is, as a rule, no inflammatory swelling such as usually follows such fractures when treated in a fracture box ; and even should inflammatory swelling appear, the plaster having been split down yields, and there is no danger of strangu lation, as there would be in a fixed and immovable plaster dressing. These two boys illustrate both the immediate application of the dressing and one of them its application to a case in which there was great contusion, the formation of blebs, and danger of the formation of a compound fracture by sloughing of the integu ments. With this dressing a patient can occupy any position in bed which is most comfortable for him. He can sit up in a chair ; can walk on crutches, and frequently, by means of it, can attend to his business during the whole time of the treatment of his fracture. If there is much contusion, the block tin tape is applied directly to the skin under the flannel bandage. If not, it is ap plied, as described, outside of it, and on the following day the cotton roller is removed and the folds of the flannel bandage are cut through with a pair of scissors, the limb inspected, any appli cations which may be needed made to it and the cotton roller reapplied. Any one who has been compelled to lie with his limb in a fracture-box for weeks must appreciate the advantages of this dressing.
DR. JOHN B. DEAVER said that since Dr. Porter made his first communication to this Academy, they had practically put it into effect in the German Hospital. They scarcely know what a fracture-box looks like. They put them up as Dr. Porter has in dicated immediately upon their being received in the hospital. It is especially applicable to children. In cases developing de lirium tremens and traumatic delirium it is particularly good. The precaution of following out Dr. Porter's instructions of cut ting down is essential, so as to avoid gangrene, which is known to occur. He had had quite warm discussions with his house doctors as to putting a limb up in plaster which was greatly swollen. The next day he would find that the patient was in splendid condition. much more so than before he was dressed. That was their experi ence in the majority of cases ; of course, there are exceptional cases. They do not confine it to simple fractures, but extend it to compound fractures ; and all know that it relieves anxiety and makes the convalescence a pleasant one in comparison with our former mode of treatment with the fracture-box.
DR. WILLARD said that in his experience there was no plan of treatment of fractures in children that is at all comparable with the proper application of plaster. In fractures of the thigh it is essential to fix the hip-joint, carrying the dressing from thorax to toes. A child then cannot displace his limb ; you can move him about, carry him up-stairs and out-doors with perfect satis faction and without any danger of disturbing the fragments. When properly used, this plan of treatment secures absolute rest to the fragments, maintains thorough apposition, and yields the very best results.