315 



the large mass of mnscles in which it is enveloped does not suffice to 

 invest it with immunity in regard to fractures. It contributes its share 

 to the list of accidents of this description, sometimes in consequence of 

 external violence and sometimes as the result of muscular contraction ; 

 sometimes it takes place at the upper extremity of the bone ; sometimes 

 at the lower; sometimes at the head, when the condyles become impli- 

 cated; but it is principally found in the body or diaphysis. The frac- 

 ture may be of any of the ordinary forms, simple or compouud, complete 

 or incomplete, transverse or oblique, etc. A case of the commiuuted 

 variety is recorded in which eighty-five fragments of bone were counted 

 and removed. 



The thickness of the muscular covering sometimes renders the diag- 

 nosis difficult by interfering with the manipulation, but the crepitation 

 test is readily available even when the swelling is considerable and 

 which is likely to be the case as the result of the interstitial hemorrhage 

 which naturally follows the laceration of the blood vessels of the region 

 involved. If the fracture is at the neck of the bone the muscles of that 

 region Ctho gluteal) are firmly contracted and the leg seems to h^ short- 

 ened in consequence. Locomotion is impossible. Crepitation may in 

 some cases be discerned by rectal examination, with one hand resting 

 over the coxofemoral (hip) articulation. Fractures of the tuberosities 

 of the upper end of the bone, the great trochanter, may be identified 

 by the deformity, the swelling, the impossibility of rotation, and the 

 dragging of the leg in walkiug. Fracture of the body is always accom- 

 panied by displacement, and as a consequence a shortening of the leg, 

 which is carried forward. The lameness is excessive, the foot beiug 

 moved, both when raising it from the ground and when setting it down, 

 very timidly and cautiously. The manipulations for the discovery of 

 crepitation always cause much pain. Lesions of the lower end of the 

 bone are more difficult to diagnosticate with certainty, though the 

 manifestation of pain while making heavy pressure upon the condyles 

 will be so marked that only crepitation will be needed to turn a sus- 

 picion into a certainty. 



The question as to treatment in fractures of this description lesolves 

 itself into the querj- whether any treatment can be suggested that can 

 avail anything practically as a curative measure, whether, upon the 

 hyj)othesis of reduction as an accomplished fact, any permanent or effi- 

 cient device as a means of retention is within the scope of human 

 ingenuity. If the reduction were successfully iierformecl would it be 

 possible to keep the parts in place by any known means at our dis- 

 posal? At the best the most favorable result that could be anticipated 

 would be a reunion of the fragments, with a considerable shortening of 

 the bone, and a helpless, limping, crippled animal to remind us that for 

 human achievement there is a " thus far, and no farther." 



In small animals, however, attempts at treatment are justifiable, and we 

 are convinced that in many cases of difficulty in the application of splints 



