The best routine will be to delay massage to near the end of the first week even when the fracture is in the vicinity of a joint, in which case it is most clearly indicated. After a few days of gentle stroking and kneading of the muscles cautious passive movements and then voluntary movements of the neighbouring joint may be permitted daily and the splints reapplied. The plan of discarding these altogether from the first, as advocated by I,. ChampionniCre, after setting the fracture is always open to the serious danger of accidental displacement during changes of posture and whilst the patient is asleep. Massage and gentle movements in order to remove swelling and pain, to prevent adhesions and to keep up the nutrition of the muscles must not be confounded with massage undertaken to cause some movement between the fragments in order to increase the production of callus, which must still he considered a doubtful practice.
The first step in the treatment of compound fractures is to insure thorough sterilisation of the wound in the skin and soft parts by flushing with an unirritating antiseptic as warm Boric Acid solution or one of the numerous l lypochlorite solutions, after which all torn or lacerated tags of soft tissue and loose particles of bone not attached to periosteum should be removed. The fragments being brought into accurate apposition, they
arc to be maintained in this position by suitable splints and the wound treated on approved surgical principles; as a rule primary skin union is not to be expected, and suitable drainage provision is usually necessary. In most cases thorough disinfection, examination, and replacement of the fragments will require a general anesthetic. In severe injury of a limb with an extensive destruction of the soft tissues and bloodvessels, and much comminution of the bone, especially with contamination from without by foreign matter, the only resource left to the surgeon will be amputation.
Fracture of the Clavicle is dealt with under its own heading.