DISLOCATIONS. 49 



COMPOUND FRACTURE. 



Unless a wound communicate with the fracture it is not com- 

 pound. The wound may be produced by the means which broke 

 the bone, by the bone protruding, or by subsequent ulceration. 

 Great danger may result from the shock, hemorrhage, tetanus, sup- 

 puration, hectic, or typhoid fever. 



Primary amputation is necessary if the bone is much shattered ; if 

 a joint, especially the knee-joint, is opened ; if large arteries are torn ; 

 if the soft parts are extensively lacerated or bruised, particularly if 

 the patient is old or enfeebled by disease. 



The treatment^ if it be determined to try to save the limb, will be 

 to convert the fracture into a simple one, by arresting bleeding, re- 

 moving pieces of bone, clots, &c., so the wound will heal without 

 suppuration. To reduce the protruding fractured extremities, it 

 may be necessary to saw off a portion; to arrest the hemorrhage, it 

 may be useful to envelope the parts in bran, or stuff the opening 

 with lint, which must be removed as soon as suppuration occurs. 



The subsequent part of the treatment may require antiphlogistic, 

 but more frequently tonic measures, such as bark, wine, good diet, 

 &c., especially if the discharge is profuse. Secondary amputation 

 may be necessary at last. 



DISLOCATIONS. 



Dislocation or luxation, is the removal of a bone from its articu- 

 lating cavity. The ball and socket joints are most liable to the 

 injury. 



The predisjoosin g causes are the peculiarity of the construction 

 of the joint, weakness or paralysis of muscles, elongation of the 

 ligaments, particular position of the parts, accumulation of fluids in 

 the joint, or diseases and fractures of the bones. 



The exciting causes are external violence ; such as blows, falls, 

 &c., and muscular contraction. 



The symiotoms are deformity, swelling, and a hollow where none 

 should be, shortening or elongation, pain and immobility of the limb. 



The conseqiieyices are rupture of ligaments, effusion of blood and 

 serum ; lymph coagulates, forms new adhesions, and fills up the 

 old socket, and the head of the bone gradually accommodates itself 

 to its new position, there always being some attempt to form a new 

 socket ; and thus considerable motion is subsequently acquired by 

 the limb. 



Dislocation is to be distinguished from fracture by the absence of 

 crepitus, the rigidity of the limb, the peculiarity of the deformity at 

 the articulation, and by the absence of deformity after reduction ; 

 whereas in fractures, it will recur without being prevented by 

 dressings. 



Treatment. — This essentially consists in overcoming the, action 

 of the muscles which retain the bone in its unnatural position, and 



