TREATMENT. - This must be begun promptly, for osseous union has been known to occur by the tenth day. By means of a director passed within the nostrils the bones are replaced. The only retentive apparatus of any value is a long pin passed directly through the nose and resting on either cheek, the nose being covered with a piece of ad hesive plaster. As a general rule, how ever, there is no tendency to reproduc tion of the deformity, and, even if such a tendency does exist, frequent reposition will appeal to the patient rather than the transfixion treatment. In old unre duced fractures an artificial bridge of aluminium, celluloid, or gutta-percha may be introduced and is well borne.
Fracture of the Malar and Superior Maxillary Bones.—Fractures of these bones beyond the subsequent liability to suppuration and emphysema are of no particular importance. If a fracture of the zygoma threatens a serious de formity, it may be remedied by inserting a sharp hook under the process and so elevating it. Fractures of the alveolar process of the jaw with displacement should be treated by wiring the teeth, or by an interdental splint (vide infra).
Fractures of the Lower Jaw.—The body, the ramus, the condyle, or the coronoid process may be fractured. Fractures of the body are, by far, the most common. They are almost always compound and occur usually in the middle line or else are double, one on each side. Unilateral fractures are com paratively infrequent. The displace ment is usually vertical and from before backward, as well. It may be appre ciated by the finger inside the mouth. In fractures of the ramus there is little or no displacement. In those of the con dyle that process is usually drawn for ward on to the eminentia articularis, the lower fragment slipping up into the glenoid cavity and so causing the chin to deviate to that side.
The diagnosis is easy except in fract ure of the ramus, where local tender ness and pain on closing the jaws may be the only symptoms.
—A mild antiseptic wash should be employed frequently to lessen the danger of infection and to clear the mouth of the foul and acid discharge from the wound. Under such treatment with efficient immobilization the wound may be expected to heal kindly, though occasionally it is impossible to prevent suppuration and necrosis.
—Though reduction is easy, the deformity tends to reproduce itself, to overcome which tendency a great number of mechanical devices have been introduced. The principles em ployed are external pressure, exemplified by the four-tailed bandage (Fig. 2), wir ing of the bone or teeth (several on either side lest they pull out), and the interdental splint. This is a piece of gutta-percha or vulcanized rubber molded to fit between the upper and lower teeth and of such width as to hold the jaws slightly separated so that fluids may be introduced through a hole bored in its centre. This is applied and the jaw bound firmly by a four-tailed band age. The first two methods may prove satisfactory; but the dental splint, though more complicated, is quite sure to give satisfaction if it is made by an expert dentist.
Fracture of the Hyoid Bone, the Larynx, and Trachea.—These rare fract ures are usually caused by direct vio lence, as in strangulation. They may be recognized by direct palpation. They endanger life by obstructing respiration. If the symptoms are urgent, tracheotomy should precede attempts at reduction.
Fracture of the Sternum.—This acci dent is very rare. It is usually caused by the strain of bending forward or back ward. The symptoms and treatment are those of dislocation (q. v.).
Fractures of the Ribs.—These are fre quent, though often multiple, and occur usually between the fifth and ninth. The upper and lower two ribs are almost never fractured. In single fractures there is, as a. rule, no displacement; but multiple fractures may give an angular displacement, or, if sufficiently exten sive, a caving in of the whole side of the chest. The fracture may be located by a localized point of tenderness (and crepitus), which may be elicited by press ure on the shaft of the bone at a dis tance from the fracture. Crepitus may also sometimes be elicited by deep in spiration, which is painful. If the lung is pierced there may be cellular emphy sema, hmmoptysis, and later a pneumo thorax.