242 OPERATIONS ON BONES. 



by the detection of crepitation from the surface, though a strong 

 confirmatory point, is scarcely sufficiently absolute to establish 

 more than a reasonable probability or strong suspicion in the case. 



In addition to the fact that the rectal examination brings the 

 exploring hand of the surgeon into near proximity to the desii-ed 

 point of search, and to an accurate knowledge of the situation of 

 parts, both ^^ro and con as respects his own views, there is another 

 advantage attendant upon it which is well entitled to appreciation. 

 This is the facility wdth which he can avail himself of the co-opera- 

 tion of an assistant, who can aid him by manipulating the implicated 

 limb and placing it in various positions, so far as the patient will 

 permit, while the sm-geon himself is making explorations and study- 

 ing the effect from within. By this method he can hardly fail to 

 ascertain the character of the fracture and the condition of the 

 bony ends. By the rectal taxis, as if with eyes in the finger ends, 

 he will " see " what is the extent of the fracture of the ilium or of 

 the neck of that bone ; to what part of the central portion of the 

 bone (the acetabulum) it reaches ; whether this is free from disease 

 or not, and in what location on the floor of the pelvis the lesion is 

 situated. We have frequently, by this method, been able to detect 

 a fracture at the symphysis, which from its history and symptoms 

 and an external examination, could only have been guessed at. 



Yet, with all its advantages, the rectal examination is not always 

 necessary, as, for example, when the fracture is at the posterior 

 and external angle of the ischium, when by friction of the bony 

 ends the svurgeon may discern the crepitation without it. 



Every variety of compUcation, including muscidar lacerations 

 with the formation of deep abscesses and injuries to the organs 

 of the pelric cavity, the bladder, the rectum, and the uterus, may 

 be associated with fractures of the hip bone. 



The prognosis of these lesions will necessarily vary considerably. 

 A fracture of the most superficial part of the bone of the ilium or 

 of the ischium, especially where there is httle displacement, will 

 unite rapidly, lea\ang a comparatively sound animal often quite 

 free from subsequent lameness. But if there is much displacement, 

 only a Hgamentous union will take place, with much deformity and 

 more or less irregularity in the gait. Other fractures may be fol- 

 lowed by complete disability of the patient, as, for example, when 

 the cotyloid cavity is involved, or when the reparatory process has 

 left bony deposits in the pelvic cavity at the seat of the union. 



