FRACTURE OF THE TIBIA This demands nothing more than exact fixation, which we get by applying a plaster cast over a stocking or one layer of flannel bandage; it must go from the toes to the tuberositas tibite, at which latter part it must be moulded very carefully. In a very few clays the children will learn how to walk in this and the fracture is united in three weeks. The part enclosing the foot is first removed and if stepping does not cause any pain the rest of the cast may be removed after a few days.
The treatment of the isolated fracture of the fibula is similar, only still simpler.
In fracture of both bones of the leg (Fig. 164, Plate LS), and when we find considerable dislocation, the cast should be well moulded and should go to the tuber ischii to ensure permanent extension (see Frac ture of the femur).
We try to transform these into simple ones with the greatest pos sible care. Trendelenburg circumcises the skin wound, removes the projecting fragment, and closes the wound by sutures. Further treat
ment is the same as in a simple fracture. In children we have not any reason for adopting radical measures. Balsam of Peru and sticky pastes are excellent means to prevent the infection from spreading, and Bier's congestion will help us to aid Nature's protective measures.
Delayed union is rarely observed in children except in rachitis. This latter demands waiting until its active stage is passed, also general and local treatment for the rachitis.
For imminent pseudarthrosis Bier's congestion and injection of blood into the periosteum arc recommended; bone suture and plates are further measures to overcome delayed union (Lexer), though we will rarely have to use these owing to the strong power of repair in children (Fig. 153, Plate 14).
The other fractures which are rarer in childhood must be treated the same way as in adults.