Ob SURGERY. 



pounds implies an open wound, communicating with the fracture ; 

 comminuted^ when the bone is broken into numerous fragments ; 

 and complicated^ when attended with luxation, laceration of large 

 vessels, &c. 



The signs of fractures are deformity, preternatural mobility, cre- 

 pitation, pain, swelling, and helplessness of the part. Old age, and 

 certain diseases of the bones, predispose to fractures ; in cold weather, 

 they are more numerous, on account of the increased muscular ex- 

 ertion necessary in walking, where there is ice. Indirect violence 

 may occasion fracture, when a force is applied to the two extremi- 

 ties of a bone, which gives way between them. Deformity may be 

 produced by an angular derangement, or a derangement in the direc- 

 tion of the axis, the diameter, or the circumference of the bone. 

 Bent bones are occasioned by a ^evf of the osseous fibres giving 

 away upon the convexity of the curve. The process of reparation 

 is more rapid in the young, and also takes place sooner in a small 

 than in a large bone. Danger results, according to the site of the 

 injury, the nature of the fracture, and the state of the system. The 

 mode of reparation is attended by the following changes : extravasa- 

 tion of blood ; after this is absorbed, the liquor sanguinis is effused, 

 and assumes the position which the blood occupied ; this consoli- 

 dates; the serous portion is absorbed; the fibrin remains, and becomes 

 organized. This period of plastic exudation lasts for eight or ten 

 days, and then becomes cartilaginous. This mass contracts, increases 

 in density, and gradually becomes bone. The ossification advances 

 from the periphery. The fractured extremities are now surrounded 

 by a bony case, termed the provisional callus ; after which continuity 

 is truly restored by the formation of what is called definitive callus^ 

 which takes place between the fractured extremities ; and, finally, 

 the provisional callus is absorbed. 



Treatment. — This consists of two parts ; first, reduction^ which 

 is to be effected gradually by extension and counter-extension, over- 

 coming muscular contraction, and coaptating the extremities ; se- 

 condly, retention^ which is effected by keeping the limb in such a 

 posture as will relax those muscles which would be likely to cause 

 a displacement, and by applying such mechanical means as will 

 prevent motion ; these means consist of splints, which are variously 

 constructed of wood, pasteboard, or metal, and applied by means of 

 bandages or rollers ; they should be light, and always of such a 

 length as to command the neighbouring joint; the inner surface 

 should be padded or lined, in order to prevent chafing. After being 

 dressed, the part should be laid upon a pillow, and not disturbed, 

 unless there should be inordinate swelling of the limb, when the 

 bandage should be loosened. Bandages soaked in gum or starch, 

 have recently been used, in place of splints. Under certain circum- 

 stances, this dressing is admirable, but an indiscriminate employ- 



