310 



If he is carried it must be by means of a wagou, a truck, or an ambu- 

 lance; the latter, being designed and adapted to the purpose, Avould 

 of course be the preferable vehicle. As a precaution which should 

 never be overlooked, a tem]3orary dressing should first be applied. 

 This may be so done as for the time to answer all the purpose of the 

 permanent adjustment and bandaging. Without thus securing the 

 patient, a fracture of an inferior degree may be transformed to one of 

 the severest kind, and, indeed, a curable changed to an incurable 

 injury. We recall a case in which a fast trotting iiorse, after run- 

 ning away in a fright caused b}' the whistle of a locomotive, was 

 found on the road limping Avith excessive lameness in the off fore leg, 

 and walked with comparative ease some 2 miles to a stable before 

 being seen by a surgeon. His immediate removal in an ambulance 

 was advised, but before that vehicle could be procured the horse laid 

 down, and upon being made to get upon his feet was found with a 

 well-marked comminuted fracture of the os suffraginis, with consid- 

 erable displacement. The patient, however, after long treatment, 

 made a comparatively good recovery and though with a large bony 

 dei)osit, a ringbone, was able to trot a^nong the forties. 



The two obvious indications in cases of fracture are reduction, or 

 replacement, and retention. 



In an incomplete fracture, where there is no displacement, the ne- 

 cessity of reduction does not exist. With the bone kept in place by 

 an intact periosteum, and the fragments secured by the uninjured 

 fibrous and ligamentous structure which surrounds them, there is no 

 dislocation to correct. It is also at times rendered impossible by the 

 seat of the fracture itself, by its dimensions alone, or by the resist- 

 ance arising from the muscular contraction excited by the surgical 

 manipulation. Tliis is illustrated even in small animals, as in dogs, 

 by the exceeding difficulty encountered in bringing the ends of a 

 broken femur or humerus together, the muscular contraction being 

 even in these animals sufficiently forcible to renew the displacement. 



It is generall}', therefore, onl}' fractures of the long bones, and then 

 at points not in close proximity to the trunk, that may be considered to 

 be amenable to reduction. It is true that some of the more sui^erfi- 

 cial bones, as those of the head, of the pelvis, and of the thoracic 

 walls, may in some cases require special manipulations and appliances 

 for their retention in their normal positions, but the treatment of 

 these and of a fractured leg can not be the same. 



The methods of accomplishing reduction vary with the features of 

 each case, the manipulations being necessarilj^ modified to meet 

 changing circumstances. If the displacement is in the thickness of 

 the bone, as in transverse fracture, the manipulation of reduction 

 consists in applying a steady pressure upon one of the fragments, 

 while the other is kept steady in its place, the object of the pressure 

 being the reestablishment of the exact coincidence of the two bony 



