CHAPTER IV - THE TREATMENT OF FRACTURE SWITH OUT PLASTER OF PARIS

Summary

How often we see plaster of Paris applied merely because X-ray examination has revealed a small crack or undisplaced fracture! On many such occasions the surgeon would probably have treated a case without plaster had he used his clinical sense alone; he would then have been treating the injury according to his estimate of the damage inflicted on the soft parts. It is a platitude to say that soft-part injuries can be more serious than mere cracks in bone. One of the commonest instances in which the clinical assessment of an injury by soft-part damage is more important than the radiological is seen in severe ankle sprains where simple X-ray reveals ‘no bone injury.’ If an ankle presents very gross swelling, with extensive ecchymosis and solid induration due to the tension of the swelling, it is highly likely that there has been a rupture of the tibiofibular syndesmosis or of the external lateral ligament, and late displacement of the talus or recurrent subluxation of the ankle will occur if too early function without plaster is permitted. On the other hand, patients are frequently prevented from returning to work by plasters which are not essential but which are forced on them by surgeons who think only in terms of routine procedures and do not adjust their method to the demands of the individual problem.

It frequently happens that a surgeon is obliged to X-ray limbs for the medicolegal implication of an injury; but the result of this examination need not make him change his clinical judgment too lightly (p. 85, Fractures of the Scaphoid).