. Modern surgery, general and operative. us. The definitive or permanent callus after a time ceases to be porousand becomes very dense bone. Compound fractures (Fig. 307) without much destruction or bruising of softparts, if treated antiseptically, soon become simple fractures and unite as the wound is not drained and asepticized and septic inflammation occurs,pus forms, and union by granulation is the best that can be obtained. Com-pound fractures by direct violence will not heal by first intention becauseof the loss of vitality of a large area of the soft parts. Delayed union is usua
. Modern surgery, general and operative. us. The definitive or permanent callus after a time ceases to be porousand becomes very dense bone. Compound fractures (Fig. 307) without much destruction or bruising of softparts, if treated antiseptically, soon become simple fractures and unite as the wound is not drained and asepticized and septic inflammation occurs,pus forms, and union by granulation is the best that can be obtained. Com-pound fractures by direct violence will not heal by first intention becauseof the loss of vitality of a large area of the soft parts. Delayed union is usually due to imperfect approximation or unstablefixation of the fragments. Imperfect approximation may result from failureto reduce the fracture (muscle, ligament, or s>Tiovial membrane being caughtbetween the bone-fragments); the use of unsuitable splints; too tight applica-tion of bandages; pregnancy; and general causes of ill health, for instance, ane-mia, scurvy, Brights disease, rickets, or s>^hilis; disobedience of the patient. Fig. 308.—Ununited fracturehumerus; unsuccessful wiring. Vicious or Faulty Union 599 or delirium tremens. In delayed union there is pain on passive motion; innon-union there seldom is. In delayed union there is loss of voluntary motion;in non-union there is power of voluntary motion (A. H. Tubby, in Brit. , Dec. 7, 1901). In delayed union there is apt to be tenderness onpressure and often a cjuantity of callus can be palpated. Delayed union isnot non-union, but may eventuate in non-union. The exact time requisitefor the solidification of a particular fracture cannot be predicted. The average,taken from a large majority of patients, is not true in a minority. For noapparent reason consolidation may require two or three weeks more than theaverage, but be accomplished at last. Mr. Jones, of Liverpool, well says thatununited fracture is often the result of surgical impatience, the surgeonfrequently examining a part in which union is slow
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