Operative surgery . ure,crushing, actual cautery (page 352), and Horsleys wax (page 568) are yetavailable for use. If the bone be comminuted and the fragments movable,they may be elevated without the use of the trephine (Fig. 372). In any eventthe trephine should be so placed (Fig. 267, &) as not to disturb movable frag-ments (c), for fear of causing them to cut or puncture the tissues lyingbeneath. In such cases the fragments should be removed with sequestrumforceps (Fig. 265, n, p) and the trephine placed on solid bone. In a casewith firmly depressed fragments (Fig. 267, d), the application
Operative surgery . ure,crushing, actual cautery (page 352), and Horsleys wax (page 568) are yetavailable for use. If the bone be comminuted and the fragments movable,they may be elevated without the use of the trephine (Fig. 372). In any eventthe trephine should be so placed (Fig. 267, &) as not to disturb movable frag-ments (c), for fear of causing them to cut or puncture the tissues lyingbeneath. In such cases the fragments should be removed with sequestrumforceps (Fig. 265, n, p) and the trephine placed on solid bone. In a casewith firmly depressed fragments (Fig. 267, d), the application of thetrephine should not be delayed by attempts with less effective means. In punctured fracture a large trephine is usually employed and so placedover the fracture, if possible, as to provide by a single button ample roomfor the removal of the fragments of the internal table. The lodgment in fissures and in bony asperities of hairs, threads, etc.,should be noted^ and their removal secured to prevent OPERATIONS ON THE NERVOUS SYSTEM. 237
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