FBACTUEES. 



307 



the reestabli^ment of the exact coincidence of the two bony surfaces. 

 If the displacement has taken place at an angle it will be suiRcient in 

 order to effect the reduction to press upon, the summit, or apex, of 

 the angle until its disappearance indicates that the parts have been 

 brought into coaptation. This method is often "practiced in the treat- 

 ment of a fractured rib. In a longitudinal fracture, or when the 

 fragments are pressed together by the contraction of the muscles to 

 which they give insertion until they so overlap as to correspond by 

 certain points of their circumference, the reduction is to be accom- 

 plished by effecting the movements of extension, counter extension, 

 and coaptation. Extension is accomplished by making traction upon 

 the lower portion of the limb. Counter extension consists in firmly 

 holding or confining the upper or body portion in such a manner 

 that it shall not be affected by the traction applied to the lower part. 

 In other words, the operator, grasping the limb below the fracture, 

 draws it down or away from the trunk, while he seeks not to draw 

 away, but simply to hold still the upper portion until the broken 

 ends of bone are brought to their natural relative positions, when 

 the coaptation, which is thus effected, has only to be made permanent 

 by the proper dressings to perfect the reduction. 



In treating fractures in small animals the strength of the hand is 

 usually sufficient for the required manipulations. In the fracture of 

 the forearm of a dog, for example, while the upper segment is firmly 

 held by one hand the loweu may be grasped by the other and the bone 

 itself made to serve the purpose of a lever to bring about the desired 

 coaptation. In such a case that is sufficient to overcome the muscular 

 contraction and correct the overlapping or other malposition of the 

 bones. If, however, the resistance can not be overcome in this mode, 

 the upper segment may be committed to an assistant for the manage- 

 ment of the counter extension, leaving to the operator the free use of 

 both hands for the further manipulation of the case. 



But if the reduction of fractures in small animals is an easy task, it 

 is far from being so when a large animal is the patient, whose mus- 

 cular force is largely greater than that of several men combined. In 

 such a case resort must be had not only to superior numbers for the 

 necessary force, but in many cases to mechanical aids. A reference 

 to the mode of proceeding in a case of fracture with displacement of 

 the forearm of a horse will illustrate the matter. The patient is first 

 to be carefully cast, on the uninjured side, with ropes, or a broad 

 leather strap about 18 feet long, passed under and around his body 

 and under the axilla of the fractured limb and secured at a point 

 opposite to the animal and toward his back. This will form the 

 mechanical means of counter extension. Another rope will then be 

 placed around the inferior part of the leg below the point of frac- 

 ture, with which to produce extension, and this will sometimes be 



