Treatment.
—As two cases of this kind are seldom alike, treatment should be planned to meet the indications. Massage, electricity, hot-air baths, and similar non-operative measures find here a large field of usefulness, but, save in the milder cases, are insufficient. In no class of cases do tendon grafting and nerve grafting find a wider range of applicability, while tenotomy, myotomy, aponeurotomy, and occasionally osteotomy will permit of atonement for deformity which has not been treated. These operative measures have been considered.
CHAPTER XXXIV.
FRACTURES.
The term fracture is, in surgery, applied to such injury of bone and cartilage as effects break in continuity. This injury is effected instantly, and it is rarely that fracture is produced by any slowly acting cause, although this latter may so affect or disintegrate bone as to permit fracture upon the application of a mild degree of force. Fractures are variously classified and grouped for convenience of description; thus we speak of traumatic and pathological fractures, implying by the former those which occur by violence in normal conditions of health, and by the latter those which are produced only because of some previous disease in the bone. The difference is that in the former case there is no preëxisting disease, whereas in the latter it is an essential feature of the case. Fractures are also classified as complete or incomplete, the former term implying injury to the whole thickness of the bone, while the latter are separately classified: (a) Fissure, in which there is a line of fracture by which there is no complete separation of fragment, it being essentially a crack; (b) the green-stick fracture, such as occurs in the young, where the bone is not thoroughly calcified, but is capable of bending to some extent, while a portion of it breaks; (c) depressed fracture, which is generally produced by direct violence, and occurs in a flat bone, i. e., the skull, the scapula, etc.; (d) detachment of a fragment or separation of an epiphysis; (e) partial fractures, corresponding much to the green-stick, but without deformity or change in shape or position.
Fig. 276
Impacted fracture of the shaft of the femur produced by a fall upon the knee in a man aged eighty-three years. Illustrating impaction. (Bryant.)
Fractures are also described by means of the following adjectives, which practically explain themselves, for instance:
A. Complete, transverse, oblique, longitudinal, dentated, etc. Spiral fracture is also described and occasionally seen. It involves only the long bones, and not only implies a considerable degree of violence, but is itself regarded as exceedingly serious.
B. In number they are single, multiple, or comminuted, as when there are a number of fragments.