. On modern methods of treating fractures . in the tibia is of bone ; that inthe fibnla is of metal. The Applicability of the Pegging Methods.—In its simpli-city and mechanical ellieiency the pegging of fractures is OPERATIVE TREATMENT OF FRACTURES 193 siij^erior to plating ; ]:)ut it has certain drawbacks and limita-tions which greatly restrict its scope. When used for a femur,especially in a young adult, it does not as rigidly maintainalinement as does the bolted plate method. It allows somuch 2^1^y between the bone ends that there is apt to be agreat callus excess. It is unsuitable if there
. On modern methods of treating fractures . in the tibia is of bone ; that inthe fibnla is of metal. The Applicability of the Pegging Methods.—In its simpli-city and mechanical ellieiency the pegging of fractures is OPERATIVE TREATMENT OF FRACTURES 193 siij^erior to plating ; ]:)ut it has certain drawbacks and limita-tions which greatly restrict its scope. When used for a femur,especially in a young adult, it does not as rigidly maintainalinement as does the bolted plate method. It allows somuch 2^1^y between the bone ends that there is apt to be agreat callus excess. It is unsuitable if there is any comminutionat the site of fractiu^e. I believe its usefulness to be restricted to transverse fracturesof the femur, humerus, and of both forearm bones. In the twoformer I would use the adjustable peg, and in the latter theshort pegs with the fixed crosspiece. In both these situationsthere is this great advantage, that the use of these pegs docsnot require a long incision nor an extensive stripping of thesoft parts from the Fig. 97.—The adjustable jjeg. A. Cross-section, open. B. Cross-section, closed. The Use of Wire. Until qviite recently, in all operations for imiting bones,silver wire was employed, and it is still a common thing tospeak of wiring fractures as though this represented theroutine operation. But it was xevy soon e^ident, when opera-tions were proposed for the attainment of perfect results,instead of being merely makeshift devices for dealing withbad open fractures, that wiring as it w^as then done wasvery unsatisfactory. Now that the plating of fractures hasbeen introduced and widely practised, Aviring has not only beengenerally abandoned, but has almost fallen into contempt. It is quite worth while to consider the factors which are con-cerned in the use of wire, to determine whether it ought to retainany place in our methods of treatment. First, then, as tothe material of which suture wire is com^^osed. Siher has beenused, not only because i
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