FRACTURES 233 



or from excessive pressure applied to a part or the whole in the adjust- 

 ment of splints and bandages. In these circumstances relief must be 

 given to the strangulated limb either by cutting the bandages or otherwise 

 removing the pressure. If it is allowed to continue, more or less extensive 

 sloughing will result, and a complication will be added to an already serious 

 condition. 



Compound Fracture. Whether the fracture be simple or compound, 

 the method employed for the reposition of the broken fragments will be the 

 same; but the presence of a wound, and maybe also the protrusion of a 

 portion of the broken bone through the orifice, will give new and special 

 features to the case which will require to be taken into account. 



Where a fragment of bone protrudes through the skin, a very material 

 difficulty is added to the operation of reducing the fracture, and serious 

 injury may have been inflicted on muscles, nerves, and vessels in its course 

 outward. 



The protruding portion, which is usually the one uppermost, will 

 require to be withdrawn into its proper position, and this will call for 

 much force, great extension and counter-extension, and dexterous manipu- 

 lation of the limb. If the projecting bone is considerable, its reposition 

 by this means may fail, and the operator will be called upon to decide 

 between two courses, viz., enlarging the opening, or sawing off a portion 

 of the exposed bone. If the former is decided upon, the enlargement 

 must be made in the direction of the axis of the bone, guarding as much 

 as possible against the division of neighbouring vessels and nerves. 



It may be that, notwithstanding this, complete return of the bone will 

 be found impossible, in which case the protruding portion, or some part of 

 it, must be removed by the saw. In carrying out this latter operation care 

 must be taken to preserve the periosteum as far as possible. 



Where the fracture is a comminuted one, some splinters of bone may be 

 found to be completely torn away from the shaft and lying loose in the 

 tissues of the part. These must be removed, and at the same time any 

 shreds of broken fascia that may be met with. In the after treatment of 

 the wound the antiseptic method must be strictly carried out. The hair 

 for three or four inches round it should be removed. The wound must be 

 freed from clotted blood by means of a sponge soaked in a five-per-cent 

 solution of carbolic acid, and freely irrigated with the same solution. 



A good pad of antiseptic gauze soaked in a three-per-cent carbolic 

 solution should be applied over the wound and parts around, and over this 

 a further succession of layers of dry antiseptic gauze, the whole being 

 surrounded by a covering of thin mackintosh or some other impermeable 

 material. 



