About pathologic fracture

Sometimes the broken fragments are impacted into each other and this may obscure the nature of the injury as deformity will not be easily detected and the use of the limb may still be present. However in almost every case of fracture there will be pain, swelling, tenderness over the broken bone and some disability.

The utmost care and gentleness must be exercised in handling a broken limb or spine. It is imperative to avoid any movement of the broken fragments, or any forward bending of the spine, lest further damage accrue to muscles, nerves, blood vessels, or the spinal cord. It is far better to do nothing until expert help arrives than to do the wrong thing. First aid implies firm gentle traction and some form of support that will prevent any movement of the jagged ends of the fragments during transport to hospital.

In any case of this type of injury Arnica 200 one or two doses should be given, followed by Arnica 30 or Ledum 30 two or three times a day for a few days to help in absorption of extravasated blood and reduction of swelling. As a further aid to firm union between the fragments Symphytum 6 should be given once a day for a week or two. This remedy has also proved of great value in cases of persistent non-union of a fracture with accompanying disability.

Frostbite

It is important to realise that this condition can occur at tempera- tures above freezing point when chilling is combined with wetting. Under these circumstances it is usually known as trench foot or immersion foot, but the underlying pathology is the same.

The cause of frostbite is undue chilling by severe degrees of cold, or lesser degrees of cold abetted by damp, wind, circulatory stagna- tion, deficient nutrition or oxygen lack. This latter is specially likely at high altitudes when climbing or flying.

The most important factor in prevention is proper clothing. Several layers are warmer than one thick one, because warmth lies chiefly in the air between the layers. Every effort should be made to keep clothes dry. Clothes and boots wet with sweat or otherwise must be dried at every opportunity. Movement is important to keep the blood circulating.

If feet or hands, nose or ears, become numb no time must be lost. The part must be gently warmed by placing it inside a companion's clothing near the skin. Any rubbing of the affected part is useless and dangerous. Above all excessive warmth must be avoided as it can only do harm by increasing the swelling. The part must be kept at rest, arm in a sling and no walking if the feet are affected.

The affected part should be wrapped in a sterile dressing. This could be wrung out of Hypericum lotion (ten drops of mother tine- ture to the half pint of boiled water) or Hypericum oil used, if available. The dressing should not be disturbed. Internally give Lachesis 30 twice daily for a few days or, if swelling is marked with burning and stinging, give Apis 30 in the same way. The chief needs are for gentle warmth, avoidance of rubbing and movement, and prevention of sepsis. Skilled surgical attention must be sought at the earliest opportunity.