FRACTURES.
Definitions.—The sudden, forcible de struction of the continuity of a bone, in whole or in part, except when done with a cutting instrument, is called a fracture (Stimson). More briefly, a fracture is a laceration or crushing of a bone. A simple fracture is one that is not com pound or comminuted. A compound fracture is one in which a wound of the soft parts establishes a communication between the fracture and the outer air. The fracture is comminuted when the bone is splintered. Multiple fractures, on the other hand, are several separate fractures in the same bone or in several bones (but this term is not applied to a simple fracture of one forearm or leg). A spontaneous fracture is one produced by an insignificant violence. A fracture occurring on account of a predisposing disease of the bone is called pathological An ununiled fracture is one in which bony union has not taken place after the lapse of the usual length of time. The terms delayed union and fibrous union usually express the same condition. A "green-stick" fracture is an incomplete fracture of the shaft of a long bone ac companied by a bending of the bone.
Varieties.—The following is the sim plest classification: 1. Incomplete fractures:— (a) Fissure.
(b) True incomplete "green-stick" fracture.
(c) Depressions.
(d) Separation of a splinter or apophysis.
2. Complete fractures, subdivided ac cording to (a) The direction and character of the line of fracture,—as trans verse, oblique, longitudinal, dentate, V- or T- shaped, and comminuted.
(b) The seat of the fracture, as fracture of the shaft of the neck, head, shaft, separation of the epiphysis, etc.
(c) If extending into a joint, intra articular fractures.
3. Multiple fractures.
4. Compound fractures.
5. Gunshot fractures.
this head are included all the changes in ap pearance and dimension of the injured part. Some deformity is always present, dependent upon the contusion or lacer ation of the soft parts, or, what is much more important, the displacement of the bone-ends upon each other. This dis placement may take place in six ways (Malgaigne), though the actual displace ment is usually the result of a combina tion of several of the original ones.
These six primary displacements are: 1. Transverse or lateral. 2. Angular. 3. Rotary. 4. Overriding. 5. Impaction or crushing. 6. Direct longitudinal separation. Displacement is caused by the combination of the trauma and the muscles attached to the fragments. Most of the various displacements can be recognized by the eye or finger, but if the seat of the suspected fracture is covered by a thick layer of soft tissues, and espe cially if the contusion of these soft parts has given rise to a considerable amount of superficial deformity, mensuration must be resorted to. Measurements are best taken from bony points at opposite ends of the bone whose fracture is sus pected, and the shortening or length ening ascertained by comparison with the distance between the corresponding points on the opposite side of the body (e.g., the sound limb). Unfortunately, however, it is often impossible to take measurements with any degree of accu racy from two points on the same bone, consequently the rule that must always be borne in mind, viz.: for a comparison of the measurements of the sound and the injured limb these measurements must be taken with the limbs in not apparently, but really corresponding positions. Two other sources of error are: first, that the length of limb in some subjects is normally asymmetrical; and, second, that previous disease may have affected the length of some one of the bones measured. Circumferential mensuration of a limb is valueless, for the increase in circumference of the in jured limb, in cases where the bone de formity cannot be readily made out, is usually due more to the effusion of blood into the soft parts than the overlapping of the bone-ends. The deformity of the soft parts is such as is caused by what ever contusion or laceration they may have received. Generally speaking, the swelling increases for twenty-four to forty-eight hours, and then gradually subsides, its subsidence being hastened by treatment: a fact which is of the greatest importance in reference to the application of splints.