THE TREATMENT OF COMPOUND FRACTURES

A Specific Technique for the Prevention and Control of Osteomylitis

¹ The Montreal General Hospital

In the treatment of severe compound fractures with extensive laceration and contamination of tissue, a specific technique is recommended. This method, which is essentially a modification of the procedure suggested by Rutherford Morison in 1916, is based upon the results obtained in the study of severe cases, already infected, observed at Alder Hey Military Orthopaedic Hospital during 1918. Since the War, the method has been more especially adapted to the prevention of infection and inflammation in civilian injuries.

The essential features of the technique recommended are:

1. Immediate operative interference and reduction of fracture, secundum artem.

2. Conservative excision and radical incision of tissues.

3. Proper bipping of the wound following dehydration.

4. Obliteration of dead spaces and prevention of adhesion of opposing wound surfaces by means of firm packing with relatively large, liquid paraffin-soaked, bipped packs.

5. Avoidance, in so far as possible, of ligatures and sutures.

6. Application of plaster-of-Paris over a thin layer of padding; no window.

7. Infrequent dressings,—the first approximately eighteen days after injury, done in the operating room under an anaesthetic; a secondary suture used and packing as indicated.

8. As soon as union commences, the application of an unpadded plaster and felt heel.

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