Reducing a Fracture

[Chantal]

To you medical folks here...How would a Pernese healer reduce a fracture and be able to do it with good alignment? How would one handle reducing a spiral fracture without reference to x-rays?

All I ever see are first-aid directions for splinting a leg; you never see the instructions for what a doctor does for a fracture, once the patient gets to the hospital.

Chantal

[Hope]

External reduction usually involves a doctor hauling the limb out with enough force to pull the bone edges apart and hopefully back together in the correct alignment. It is painful for the patient and physically demanding on the surgeon, and afterwards you recheck xrays. Without xrays...well, on Pern, walking again is the sign of a well healed broken leg. No one expects that you'll ever run or dance again, though some will. A spiral fracture may never heal, and if blood supply is too compromised, the bone will die. Avascular necrosis is bad, and not fixable on Pern.

So how about our Earth standby of ORIF?--Open Reduction, Internal Fixation, like my Mom just had--they opened her up, aligned the edges, and pinned them together. I'd say that that's officially a bad idea on Pern...without IV antibiotics and true sterile technique, germs in the bones is nearly certain. Osteomyelitis is incredibly difficult to treat on Earth! Then, the operation takes 90 minutes if all goes well--a significant risk with more primitive anesthesia! Impossible without anesthesia. Blood loss with modern tech and techniques is about 500 ml, or roughly a pint; with more primitive techniques, blood loss alone could be fatal!

OK, at this point you're probably thinking I'm done with bad news, but there's more! Doing external rotation to set a bone--the pull and yank method--can sometimes sever an artery on a sharp bone edge...and then, you may very well be dead. It doesn't happen that often, but when it does....

I am not an orthopedist, and other people here may have better information...but from my perspective, you place the limb into a neutral position, yank it into the proper alignment, and pray. Or, since there's no divine influence on Pern (and how do Healers survive?), probably swear.

[Chantal]

I am now wracking my brain to try and remember if I ever had Aerden set any bones. (Oh, God--Z'leena broke her leg that one time.) I actually needed to know with regard to a Star Trek sim I'm in, in which my character had to reduce a fracture, but I figured it would be a necessary thing to know for Aerden, as well.

I like Pernese medicine better than Star Trek medicine. With Star Trek medicine, you might as well just wave a wand and say, "Orthosteogenesis!" Thank you for reminding me about ORIF, though. Next time someone breaks a bone--at StarRise or on the USS Courageous, I'll be able to deal with it accurately.

Chantal
("Why, yes, that was a shameless plug for my ship. I hope that's okay!")

[katah]

Not a doc, here, but thinking of playing one on TV. So, when do bone fragments dislodging come into play? Or am I imagining things?

[Chantal]

Any time they try to puncture organs or tissue. They can be really bad if they puncture the lungs, and they can hurt badly if they rub against muscle or nerve, I'd think.

[Trini]

Not only that--remember in A Separate Peace (had to read in High School). That kid broke his leg, then died when a piece of the marrow got into his blood stream and caused an embolism. (I think that's what it was. It made a big impression on me.)

For compound fractures of the limbs--especially open fractures-- I'm betting that in a lot of cases, the best chances for the patient to survive would be amputation. (Like I said, I often think of 19th century medicine (often battlefield medicine) when thinking about Pern.)

[katah]

I think it would be grand to come to some understanding with surgery and breaks and such and what can be expected in the environment of the pern world. Then, we can have all kinds of fun writing about people who want to make break-throughs (without the kinds of trials available to modern medicine) and those that want to buck the system and try dangerous things in the spur of the moment when faced with an actual patient in need and not wanting to loset them (as different from research and proposals on how things might be handled).

[Hope]

Oh, somebody brought up compound fractures...

The thought of trying to fix that on Pern is frankly terrifying to me. But if I was going to try that...I'd clean the wound as best I could, sedate the patient as possible--probably with alcohol, possibly with ether--grind down the sharp bone ends slightly, douse the whole mess with the strongest rot gut alcohol I could find, then get a pulley or a really strong person to pull the limb out far enough that the bone piece could slide back inside the skin and muscle. Then I'd sew it, but leave an area to drain, and if the patient was still alive, I'd get roaring drunk.

I'm betting the only people here who may ever have seen anything remotely like this would be one of our Veterinarians...and if you have, speak up! I will happily bow before greater experience.