The ordinary indications of fracture are frequently followed by ecchymosis. This will appear at a date corresponding with the depth of the injury beneath the skin (it may occur within an hour or three or four days). The blood will follow the fascial planes and work its way to the surface along them. The sign is of the greatest value in the diagnosis of basal fractures of the skull and certain fractures of the hip and pelvis. When it occurs after an interval it is a confirmatory rather than a promptly available sign.
Redisplacement implies that the parts when properly put into apposition quickly fall out of it unless mechanically supported—that is, they do not stay reduced. This sign is not universally applicable. It applies especially to the fractures of the long bones of the extremities, and particularly to the humerus, the femur, or double fractures of the radius and ulna in the forearm or both bones of the leg.
Diagnostic Aid Afforded by the Fluoroscope and the Skiagram.
—Since Röntgen’s memorable discovery the cathode or x-rays have been of greater and greater use in the diagnosis and portrayal of injuries and morbid conditions in the osseous system. To such an extent is this now true that well-equipped hospitals have ample conveniences for fluoroscopic and photographic work, while many medical men are doing it in their private practice. There can be no question but that diagnosis and methods of treatment have been made more perfect since this new method of investigation has been made available. On one hand, however, it has led perhaps to something of neglect of the methods previously in vogue, which necessitated anatomical knowledge and logical reasoning. On the other hand, the knowledge thus obtained has been sometimes a two-edged sword, since the display of skiagrams, or x-ray pictures, in court has too often worked harm or discredit to the surgeon or the institution with which he was connected. Moreover, even this method of diagnosis, with its apparent certainties, is not always reliable, and disappointments have sometimes followed.
Intra-articular Fractures
are subject to peculiar complications which enhance the difficulty of treatment and jeopardized the result. Among the more common of these are the following:
1. Too wide separation of fragments by hemorrhage or distention, with failure in resorption of fluid before fixation in bad position has resulted.
2. Complete or partial rotary displacement, preventing proper apposition of bone surfaces.
3. Interposition of soft or fibrous tissues between fragments by which bony union is prevented. This is conspicuously common in fractures of the olecranon and patella, and is of itself sufficient reason to justify operation in otherwise suitable cases.
4. Separation of a fragment within a joint capsule, by which its blood supply is cut off, making it essentially a foreign body. This occurs especially at the anatomical necks of both the humerus and femur.