. Modern surgery, general and operative. Southam, of Man-chester, in an impressive article has insisted on the absolute necessity of pullingapart an impaction. He gives ether, and when the patient is anesthetizedunlocks the fragments.^ This unlocking is best accomplished by abduction,the rim of the acetabulum acting as the fulcrum of the lever (Whitman). Intreating extracapsular fracture we can use the extension apparatus with sand-bags (see page 670) for three weeks and then apply a plaster dressing. Get thepatient on crutches after the plaster has been in place for two weeks. Removethe plast
. Modern surgery, general and operative. Southam, of Man-chester, in an impressive article has insisted on the absolute necessity of pullingapart an impaction. He gives ether, and when the patient is anesthetizedunlocks the fragments.^ This unlocking is best accomplished by abduction,the rim of the acetabulum acting as the fulcrum of the lever (Whitman). Intreating extracapsular fracture we can use the extension apparatus with sand-bags (see page 670) for three weeks and then apply a plaster dressing. Get thepatient on crutches after the plaster has been in place for two weeks. Removethe plaster at the end of four weeks. Thomass splint may be used instead ofBucks extension. Some prefer one of the apparatus shown in Figs. 399,400,403. Fractures of the Femoral Neck in Children.—Fracture of the femoralneck in children and in young adults can scarcely be regarded as very unusual,and is certainly more often encountered than separation of the upper epiph- ^ Lancet, Dec. 21, 1895. 676 Diseases and Injuries of the Bones and Joints. ysis. The accident results from a fall rather than, as so often in an adult, froma twist, and it is the product of considerable violence rather than of sHght children such fractures may be impacted, and most of those which are unim-pacted are of the green-stick variety. The disability is not nearly so great asin an adult; in fact, it is not unusual for the victim of such an injury to be ableto hobble about a few days afterward. The symptoms are shortening, someeversion, impairment of joint movements, and a limp when the patient getsabout. Fractures of the hip in children are often unrecognized and lead fre-quently to permanent impairment because of the development of coxa .T-rays should be used in making the diagnosis. A green-slick fracture may be treated with Thomass splint, and after fourweeks in bed the child may be allowed up, wearing a traction hip-splint for several months until union is so firm thatthe danger from coxa
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