172 PEINCIPLES OP TETEEINAEY SUBGEBT 



Sow do you treat complicated fractures ? 



Formerly , compound fractures necessarily were looked 

 upon as exceedingly dangerous accidents, but antiseptic 

 surgery has taught us liow to disinfect a ■wound and tliua 

 reduce septic dangers to a minimum. The treatment of com- 

 pound fractures differs radically from that of a simple or- 

 subcutaneous fracture, by reason of the fact that the former- 

 is complicated by a wound and therefore exposed to septic 

 sequels. The sine qua non in the treatment of a compound 

 fracture is exhaustive disinfection of the wound of the soft 

 parts and drainage when necessary. 



1. When the wound of the integument is small and clean,, 

 disinfect it ; set the fracture, apply an antiseptic dressing to 

 "wound and over it place the plaster of paris bandage. 



3. When the fracture is complicated with decided lacera- 

 tion of the soft parts, bony fragments perforating the skin or- 

 a joint open, disinfect every nook and corner of the wound,, 

 trim the sharp points of the bony fragments, ligate bleeding 

 vessels, cut away contused tissues, remove foreign bodies, etc. ;; 

 m.ake counter-openings for irainage, arrange the bony frag- 

 ments, siiture the cutaneous wound as far as possible, pre- 

 viously tamponing the wound cavity with iodoform gauze, 

 and apply a temporary dressing, changing it at regular inter- 

 vals. The plaster of paris bandage in these cases is to be- 

 applied as soon as the wound is healed. 



3. Fractures with septic infection — that is, those older- 

 than one or two days — are also "purified "and best treated, 

 "by continuous irrigation, applying such a temporary dressing 

 as will permit of limited disturbance of the bony f ragmentsv 



4. Fractures "where the parts are simply ground to piecea 

 or those where the dangers of a general infection is marked. 

 Thorough disinfection is to be tried, and when insufficient,. 



