FRACTURE OF THE THIGH In this fracture we must always be very careful in adapting the fractured ends and in avoiding shortening, which is always threatened (oblique fracture, strong muscles).
For the first few days, extension with heavy weights and counter extension on the pelvis and ice to prevent late hemorrhage. After three or four days, when the swelling has subsided, we put on a well-fitting plaster cast which includes the pelvis and leg. It should fit especially well over the crests of the ilium, the tuberositas isehii, the eondyli femoris and the patella and should be padded as little as possible (see Coxitis splint); below the knee it should be loose so as not to interfere with extension and keeping off the weight (Fig. 174a). It reaches down to above the ankle and to it is fixed a stirrup; the ankles are held in a boot from which two or four straps run through slits in the plate of the stirrup to which they are fastened on the outside with but tons. Thus we can keep up the degree of extension which we had succeeded in getting upon the extension-table (control by marks upon the ankles with iodine). We can also make removable celluloid-steel-wire casts according to the same principles (Fig. 174b).
More radical measures, such as continuous extension with weights, nail-extension according to Co(livilla-Stcinmann, are not required in chil dren because their muscles do not produce sufficient traction.
The results of the ambulatory treatment are better than of insuffi ciently watched extension in bed, and this latter is very hard upon children for any length of time.
We leave off the boot extension after two weeks and the stirrup after four weeks, so that the child can then step upon its foot. After the fifth week we shorten the cast to the knee, and take it off entirely after six weeks, provided the child is not afflicted with active rachitis. In small children up to three years we prefer the above-described sus pension, combined with splints.
The rarer fractures near the knee-joint arc treated the same way. Naturally we will first have to replace the short lower fracture either by manipulation or by operation, and we may have to apply lateral trac tion to keep it in position (Fig. 175).