SURGERY. 
fore-arm. 'riie limb is to be in the mid 
state, between pronation and snpination ; 
ajid the inner splint should reach far enough 
into the hand to support it, and prevent it 
from falling into the prone state. 
In fractures of the olecranon the elbow 
must be placed straight, to approximate as 
much as possible the broken ends, and the 
limb must be continued in that position un- 
til the patient has recovered. 
When the os femoris is broken, there is 
severe local pain, an incapacnty to move 
the limb, a distinguishable crepitus on mo- 
tion, and deformity of the part from retrac- 
tion of the lower portion. The latter ap- 
pearance will occur more readily, in pro- 
portion as the fracture is more oblique ; and 
it arises entirely from the action of the 
muscles which are fixed in the bone below 
the fracture, together with the flexors of 
the knee. Besides the shortening of the 
limb, produced by the retraction of the 
lower portion of the fractured bone, there 
is another deformity arising from its being 
rotated outwards ; an effect produced by 
most of the large muscles of the thigh. 
The higher the fracture, the more difficult 
is it to^ prevent displacement. When the 
neck of the thigh bone is broken, there is 
severe pain in the groin, much aggravated 
by motion of the part. The extremity is 
shortened, the limb turned out, and the 
trochanter higher than usual towards the 
pelvis. Yet the limb may be drawn down 
to its natural length, in doing which a cre- 
pitus is sometimes perceived. In order to 
relax as much as possible the muscles which 
.tend to displace the broken bone, a bent 
position of the thigh and le^ was recom- 
mended by Mr. Pott. He recommended 
that the patient should lie on the side of the 
fractiue, with tlie thigh bent on the pelvis, 
and the knee half bent. A broad splint 
well padded should be placed under the 
thigh, from above the trochanter to below 
the knee, and another should extend from 
the groin below the knee on the opposite 
surface. Narrower splints should occupy 
the intervals between those on the inside 
and outside of the thigh. I'be splints 
should be fastened as firmly as they can be 
borne, by means of leathern straps. A pa- 
tient with a broken os femoris should by no 
means be placed on a soft bed, as the trunk 
of the body depresses it into a hollow', and 
by sliding downwards increases the dis- 
placement. 
Fracture of the patella is generally caused 
by violent exertion of the muscles, whose 
tendons are inserted into this bone, and not 
by direct violence. The upper end of the 
bone is drawn upwards by the muscles, and 
a total inability to extend the leg is gene- 
rally observed. The muscles should be re- 
laxed, by extending the knee, and bending 
the thigh on the pelvis ; they may also be 
surrounded with a roller, a compress being 
placed just above the upper portion of the 
broken bone. The newly-foi med substance 
which unites the broken ends is of a liga- 
mentous or cartilaginous nature, and not 
bony. 
Fractures of the leg. If they affect both 
bones, there can be no doubt of the nature 
of the case ; but the symptoms are more 
uncertain, when the fibula alone is broken. 
The limb should be laid on its outside, with 
the knee moderately bent. Japanned iron, 
or wooden splints shaped to the part, and 
covered with soft pads, are employed. The 
leg having been placed in the above-men- 
tioned position, extension is made, if ne- 
cessary ; and the under splint, covered witir 
its pad, and having an eighteen-tailed ban- 
dage laid on it, is passed under the limb. 
Having observed that the ends of the bones 
are in exact contact, the surgeon places his 
soap plaister over the fractured portion, and 
lays down the bandage. Another soft pad 
is then put over the upper surface of the 
leg, and the other splint applied. The lea- 
ther straps attached to the splints are fas- 
tened with sufficient tightness, to prevent 
any motion of the fractured part. When 
the pressure of the splints is painful, soft 
pads are necessary. 
Ruptured tendo Achillis. The large ten- 
don of the muscles of the calf of the leg 
is sometimes torn asunder by the violent 
exertion of those muscles. An inability to 
extend the ankle, and a consequent im- 
paired power of progression follows. The 
ends of the tendon maybe approximated 
by straightening the ankle and bending the 
knee. The foot may be kept in this posi- 
tion by the assistance of baudage.s. The 
case requires about the same degree of 
confinement as a fracture. Some persons 
have not kept their bed for this accident, 
but have walked about with a high-heeled 
shoe. The tendon of the plantaris muscle 
is sometimes ruptured, and the accident is 
attended with the symptoms as if the tendo 
Achillis were torn. 
P.-VUTICULAR DISI.OCATIONS. 
Lower jaw. This bone can only be lux- 
ated forwards, when the condyloid pro- 
\ -2 . 
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