PSEUDARTHROSIS, OR DELAYED UNION'. —When on account of a constitutional taint (e.g., syphilis), a drain on the sys tem (pregnancy, lactation), a cachectic condition, or most commonly an imper fect reduction or inefficient immobiliza tion of the fragments, the fibrous callus which unites the fragments fails after a sufficient length of time has elapsed, the bone-formation should be stimulated by attention to the patient's general condition and such measures as will produce local irritation. Among the local measures the most successful have been the production of congestion by occasionally constricting the limb above the point of fracture for a suffi cient time to cause decided venous con gestion, the injection of a few drops of a 10-per-cent. solution of the chloride of zinc into the callus, the use of electricity with one needle in the callus and the other on the surface of the limb, or the wearing of a splint loose enough to allow a slight amount of motion at the point of fracture. These failing, the only al ternative is to cut down on the fracture, to cut away the callus, and suture the bones into place with catgut. If a gap remains this is to be filled by decalcified or powdered bone. A gap in the tibia may be done away with by removing a section of the fibula. The use of wire is contra-indicated here as elsewhere, ex cept for temporary service. One need scarcely add that if the defective union is due to the general condition of the patient, no amount of operating will make the fracture unite so long as that condition persists.
Nearthrosis, a very rare condition, in which the bone-ends are separated by a joint-cavity, demands operative inter ference.
Faulty or angular union may be reme died by osteotomy.
Special Fractures.
Fractures of the Skull.—VARIETIES. —Instead of dividing these fractures, according to their location, into fract ures of the vault and of the base, it is more intelligible to speak of 1. Circumscribed fractures, with little injury to the brain.
2. Fissured fractures, usually associ ated with serious brain-lesions.
3. Intermediate and irregular fract ures — the intermediate fractures that combine some of the features of each of the above varieties.
Circumscribed fractures being usually caused by a sharp blow from some pointed object, the skull is crushed locally, without any great injury to the underlying parts. In typical cases, after the shock of the blow has passed off there is no further danger or inconven ience, except the danger of infection, for almost all fractures of the skull are compound. Sometimes the outer table alone, again (but rarely) the inner table alone, and usually the whole thickness of the skull is depressed. Yet there may be no depression, the skull being simply split (locally) at the point of fracture.
The diagnosis may be easily made by inspection and palpation. If, however, the fracture is not compound, a ridge of clotted blood may feel like the over hanging edge of the uninjured bone over a depression; but in the case of the clot the finger goes up one side of the ridge as well as clown the other, and does not simply slide over the ridge, and firm pressure will indent the clot, but not the skull.