Fibrous union is a common result in fractures of the neck of the femur in old people and in certain other fractures, such as fracture of the patella, of the olecranon, coronoid and coracoid processes, and although this does not necessarily involve interference with function, the patient should always be warned of the possibility.
Impairment of growth and eventual shortening of the limb may result from involvement of an epiphysial junction.
Stiffness of joints is liable to follow fractures implicating articular surfaces, or it may result from arthritic changes following upon the injury.
Osseous ankylosis is not a common sequel of simple fractures, but locking of joints from the mechanical impediment produced by the union of imperfectly reduced fragments, or from masses of callus, is not uncommon, especially in the region of the elbow.
Wasting of the muscles and œdema of the limb often delay the complete restoration of function. Delayed union, want of union, and the formation of a false joint have already been referred to.
Treatment.—The treatment of a fracture should be commenced as soon after the accident as possible, before the muscles become contracted and hold the fragments in abnormal positions, and before the blood and serum effused into the tissues undergo organisation.
Care must be taken during the transport of the patient that no further damage is done to the injured limb. To this end the part must be secured in some form of extemporised splint, the apparatus being so designed as to control not only the broken fragments, but also the joints above and below the fracture.
When the ordinary method of removing the clothes involves any risk of unduly moving the injured part, they should be slit open along the seams.
The patient should be placed on a firm straw, horse-hair, or spring mattress, stiffened in the case of fractures of the pelvis or lower limbs by fracture-boards inserted beneath the mattress. Special mattresses constructed in four pieces, to facilitate the nursing of the patient, are sometimes used.
In many cases, particularly in muscular subjects, in restless alcoholic patients, and in those who do not bear pain well, a general anæsthetic is a valuable aid to the accurate setting of a fracture, as well as a means of rendering the diagnosis more certain.