. Railway surgery : a handbook on the management of injuries . sepsis finds its way more easilyinto the wound to such an extent as to ver3r materiallyaffect the final prognosis of the case. Hence it is evidentthat special consideration and care have to be exercisedin order to overcome these influences. Again, the force causing a compound comminuted frac-ture of a strong bone is frequently expended on otherparts of the body at the same time, and remote lesions,either apparent or obscure, are very apt to be influentialfactors in directing the case into unfavorable channels. Diagnosis. The diagno
. Railway surgery : a handbook on the management of injuries . sepsis finds its way more easilyinto the wound to such an extent as to ver3r materiallyaffect the final prognosis of the case. Hence it is evidentthat special consideration and care have to be exercisedin order to overcome these influences. Again, the force causing a compound comminuted frac-ture of a strong bone is frequently expended on otherparts of the body at the same time, and remote lesions,either apparent or obscure, are very apt to be influentialfactors in directing the case into unfavorable channels. Diagnosis. The diagnosis of fracture is comparatively easy. Thepatient being conscious in the majority of cases, he is ableto point out the site of his injury. If the fracture issimple, the ordinary signs of it will be present. Inabil- H4 RAILWAY SURGERY. ity to use the extremity, pain, increased mobility in hand-ling, crepitus, and some deformity depending on the loca-tion of the break, are the points to determine. None ofthese signs is independently pathognomonic, but must be. Fig. 45.—Fracture of both Bones of the Forearm, showing- the marked deformity. coupled with others with sufficient certainty to establishthe diagnosis. Many times, and it may be said usually, a fractureneeds but a glance or a touch to be recognized (see ), although in some forms of impacted fractures, or in casethe individual is fleshy, some obscurity is often present. Inability to use the part, in complete fracture, is causedby the loss of the natural support, and the pain upon at- FRACTURE OF THE EXTREMITIES. 115 tempts to move it. Crepitus is not always distinctly madeout, while a sensation similar to this is at times producedby tendons or cartilages rubbing against one deformity must be weighed with other signs when inthe proximity of a joint, in order not to be confounded witha dislocation. When an irregularity of outline presentsaway from a joint, or in the shaft of a bone, it is especiallysignific
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