46 



SURGERY. 



upper fragment being tilted forward by the action of the psoas mag- 

 nus and iliacus internus muscles. 



Treatment. — The principles of treatment are, as in. all fractures, 

 coaptation and retention, but the means to effect it are various. 



The double inclined plane is a simple contrivance. The leg is 

 secured to one plane, which furnishes the means of counter-extension, 

 and the thigh rests on the other ; the weight of the body produces 

 the extension. 



DessauWs Apparatus. — Consists of an outer splint, three or four 

 inches wide, reaching from the crest of the ilium to four inches beyond 

 the foot, each extremity having a hole in it ; an inner splint reaching 

 from the perineum to the sole of the foot, and an upper splint reach- 

 ing to the knee. 



The counter-extension is made by a band in the perineum, which 

 is secured to the upper end of the outer splint by means of the hole 

 in it. The extension is made by a band or handkerchief applied to 

 the ankle, and secured to the hole in the lower end of the outer splint. 

 Liston uses only the outer splint, as represented in the figure. 



Fig. 7. 



Dr. PhysicJc's modification consists in an elongation of the outer 

 splint, nearly to the axilla ; by this means counter-extension is made 

 in a line more nearly parallel with the axis of the body, and a block 

 was placed upon the inner side of the lower end of the same splint, 

 below the foot, for the purpose also of preventing the line of exten- 

 sion being oblique, which might produce pain and deformity. Bags 

 of bran are placed on each side of the limb, so as to secure uniform 

 pressure from the splints, and the whole is secured by bandages. 



HagedorrCs Apparatus consists of one splint reaching from the hip 

 to a foot-board. 



The counter-extension is made at the acetabulum of the sound 

 side, and the extension by the foot of the injured side. The splint 

 is first applied to the outer side of the sound limb, and the foot 

 secured to the foot-board ; and the extension is made by drawing the 

 foot of the fractured limb down to the foot-board, and securing it. 

 This avoids the necessity of a perineal band, which may excoriate. 



Dr. GibsorCs modifix:ation of this apparatus consists in an elon- 



