926 FRACTURE OF THE FEMUR. 



primary intent ion if immediately sutured with antiseptic precautions, 

 and dressed with a disinfectant like iodoform -tannin. Union is 

 assisted by protecting the wound with a clean cloth, which is kept 

 moistened with a disinfectant. Rest is absolutely necessary. 



Muscular wounds in this position heal most rapidly under a scab. 

 If, as is not infrequently the case, the entire wound-surface is open 

 to the air, this will be found the best procedure. The wound is 

 carefully cleansed, rinsed with a disinfectant, any loose fragment 

 of tissue is removed, and after bleeding vessels have been ligatured, 

 the parts are powdered with iodoform -tannin. As a rule, this 

 produces a dry scab, which is firmly adherent to the wound ; nothing 

 further is required. If the scab separates at certain points, it should 

 be removed, the discharge wiped away with a little wadding, and 

 the dressing renewed. Sometimes only the upper part of the wound 

 heals under the scab ; but though the lower portion is wet with 

 discharge, granulation and healing are only delayed, not prevented. 

 When the surfaces of the wound are in contact, or when pockets or 

 deep injuries exist, it is difficult to maintain asepsis, and suppuration 

 almost always occurs ; in such cases, drainage must be assisted 

 and extension of suppuration checked by a free use of the knife, by 

 making counter-openings, and possibly by inserting gauze drains, 

 the wound being meanwhile frequently cleansed, 



Even when healing by first intention seems out of the question, 

 recovery may be shortened by inserting stitches, particularly if the 

 skin be separated from subjacent structures to any great extent. 

 By bringing the flaps of skin together with thick threads, or, better 

 still, with tape, which is not likely to cut, retraction of the cicatricial 

 tissue in the edges of the wound is checked, and in large wounds 

 healing is assisted. 



Sinuses extending to the tuber ischii must be laid open, and the 

 necrotic piece of bone removed. 



II.— FRACTURE OF THE FEMUR. 



In spite of its protected position, the femur is not infrequently 

 fractured in the different species of animals — in dogs, by treads, in 

 horses and oxen by kicks and falls. Horses fracture the bone by 

 struggling violently when cast, especially if the foot be fixed too 

 high (that is, if the hoof be drawn up over the elbow-joint), and over- 

 extended whilst in this position. Gurlt thinks that tying the hind 

 limb to the cannon bone of the fore limb may cause fracture of the 

 femur ; but though German operators often fix horses in this way, 



