American practice of surgery : a complete system of the science and art of surgery . is the more serious. It generally affectsyoung people and renders them almost helpless. Of the 166 cases in Agnewstables, in 11 amputation was done, while of the 226 involving the humerus, * Trans. Orthop. Assn, 1898, \. York Med. Journ., 1S97, lxvi. 246 AMERICAN PRACTICE OF SURGERY only 7 were thus treated. After failure from the ampler methods of treatment, the open operation will be strongly indicated. The chief difficulties arise fromthe failure, frequently, to expose the fragments properly; from the
American practice of surgery : a complete system of the science and art of surgery . is the more serious. It generally affectsyoung people and renders them almost helpless. Of the 166 cases in Agnewstables, in 11 amputation was done, while of the 226 involving the humerus, * Trans. Orthop. Assn, 1898, \. York Med. Journ., 1S97, lxvi. 246 AMERICAN PRACTICE OF SURGERY only 7 were thus treated. After failure from the ampler methods of treatment, the open operation will be strongly indicated. The chief difficulties arise fromthe failure, frequently, to expose the fragments properly; from the greater op-portunities for infection than in most other hones: and from the greater obstaclesto keeping the fragments together and immobilized. These difficulties are con-siderably increased if the pseudart hrosis is well established, especially if othermethods have been tried and have failed; where there has been little or no at-tempt at new hone formation, and more particularly if marked atrophy of thefragments exists or necrosis of a loose fragment from infection in a compound. Fig. 126.—Transverse Section in the Middle of the Thigh. (Original.) a, Deep femoral vessels;6, great sciatic nerve; c, superficial femoral vessels. fracture, or from a comminuted fracture. The incision, which should he free,may be made anteriorly or externally, since the hone is nearest those surfaces,and all vessels and nerves are avoided (see Fig. 126). Parkhill made it ante-riorly, while Treves advises the external incision. The seat of fracture beingexposed and the fragments freed from the surrounding tissues, the periosteum israised from the edges of the fragments and the fractured surfaces are may be accomplished by pushing each fragment in turn out of the wound,and sawing off a thin slice from the end of each fragment if the fracture is trans- PSEUD ARTHROSIS. 247 verse, or, in the case of an oblique fracture with little displacement, by bendingand separating the fragments suf
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