British medical journal . remultiple wounds are present, a second operator should getto work on them at the same time that the femur is beiagtreated. The only reference I will malie to the questionof the choice of au anaesthetic will be to point out theadvantage of spinal anaesthesia in some cases of fracturedfemur—for example, when associated with a penetratingchest wound. Shock must be vigorously combated on the operatingtable. Warm blankets, hot-water bottles, salines, sub-cutaneously or intravenously, should be used. In all gravecases, tfie latter is the method of choice, and it should bee
British medical journal . remultiple wounds are present, a second operator should getto work on them at the same time that the femur is beiagtreated. The only reference I will malie to the questionof the choice of au anaesthetic will be to point out theadvantage of spinal anaesthesia in some cases of fracturedfemur—for example, when associated with a penetratingchest wound. Shock must be vigorously combated on the operatingtable. Warm blankets, hot-water bottles, salines, sub-cutaneously or intravenously, should be used. In all gravecases, tfie latter is the method of choice, and it should beemployed at the start of the operation. As soon as the AUG. iS, 1917] COMPOUND FKACTUKE OF FEMUR. [thk BammMiDICAI. JoCBIt&L 213 patient is anaesthetized be is liftecl off the stretclier,splints are lenioved, and clothing cut away. The limb isthen raised from the tabic by means of a rope and pulleyapparatus, attached to a clove hitch round the ankle (seerig. 1). By this means the limb can bo elevated and ROOP OR BEAM. Fig. l.^Fvactiire of feninr. Diagram of roiie and pulleyapi)araUls for ruVbiuu leg from operating table. extended at the same time. This simple device frees theorderly from the somewhat arduous task of holding up theliuih during the whole period of the operation. The preparation of the skin must be thorough. A widearea round the ^vound or wounds and the whole circum-ference of the limb should be treated, as unexpectedlyextensive incisions are often necessary. An important detail is the secure fixing of sterilizedtowels round the upper part of the limb. CHps should beused which fix the towels to the skin, as they arc apt tobecome displaced during the changes in position of thelimb which have to be made in the course of the leg and foot should be wrapped iu a sterilized towel,under cover of which is the suspension sling, or the baudsof the orderly supporting or adjusting the leg. The first step in the actual operation should be excisionof the superfic
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Keywords: ., bookcentury1800, bookdecade1850, booksubjectmedicine, bookyear185
