The Cordova daily times., 1917-03-14

operation will greatly aid in keeping the field dry. If there are any small fragments or splinters remove them, together with all clots. Manipulate fragments to position, clamp and fix with Lane plate and screws. IT you are In doubt about one being suffi- cient, put on another. The bone frag- ments must only be handled with in- struments where possible The wound is now closed, care taken to fill in all dead space and a cast applied. Move the limb as little as possible after the plates are made fast. The wound Is dressed through window in cast. say, "use plates," because for the sur geon doing only an occasional opera tion of this nature, it is the simplest, easiest and quickest method, and where they are deeply buried they are not apt to give trouble. If they are near the surface (tibia, for instance), they will probably have to be removed at second operation.
 There are other methods of merit, especially the use of autogenous splints or gratis, but the cutting of these, unless one has a motor saw, is very tedious proces, making long drawn-out operation, causing more shock to the patient, and in the end | sepIlrinp m hettpr results
 If conditions are unfavorable for an operation, then some method of ex- tension must be resorted to.
 | In my series of cases there has been nineteen cases of fracture of the fe moral shaft. I used the Buck exten- sion method on my first cases of ob lique fracture, and although I got firm union in all but one case, I always got some shortening, from IA inch to 1-2 inch. l therefore concluded that the Buck method is inadequate and should l have occasion to use extension again I shall use the method advocated by Steinman. That is, by driving nail | thl ou6h 'hO io"Ci oVShchst 'l ~ tiuST ture of the femur, just above 2ondyle, and if of tibia and fibula, through the oscalcis, and making traction on each end of this by wire loops connected with ropes which run through pulley made fast to the bed.
 It was my pleasure in January of l hn ta har of cases being treated by this method in the Cook county hospital, and I shall take pleasure in trying to describe it here.
 An ordinary pointed wire nail about six inches long is used. This can be placed in position with the patient fully anesthetized, or by the use of a local anesthetic with little pain to the patient The site of the nail is select ed, taking care to keep away from the medulary canal if possible; If a long bone, preferably near the epiphysis. The site and exit of introduction are sterilized by the benzine-iodine me thouI anu d otop ihSioioh biauC down to the bone. The nail is then inserted and driven through, holding block of wood or some heavy body | covered with sterile gauge or towels against the opposite side of the limb. When the skin is pushed out on the opposite side by the nail small incis- ion is made here and the nail pushed through. The wound at the entrance and exit of the nail is then sealed with collodion and covered with a sterile gauge dressing, and a copper wire about two feet long with loop at each end of the wire is placed over the nail ends and held in position with a rob Ter bandage. To this is made fast rope which runs through pulley at the foot of the bed. This eliminates all stress upon joints and soft parts. This allows as much weight as is necessary to reduce and maintain extension un- til the bones are partially united. Ro- tation of the limb can be controlled py pioSihS "Si6hl oh SiehCi Ohu ol thO nail. This nail is left in situ for about eighteen or twenty days, numerous X-rays being taken to determine if enough weights are being used and If the fragments are in proper position. for compound fractures with infection, , this is by far the best method have ever seen in use. It maintains the fragments in proper position and al lows all the space about the fractures for dressing and treatment.
 The difficulty with the Buck exten- sion method was that in fractures of the femur, not enough weights could ) be applied to maintain extension and the plaster always came off in a short time, which necessitated putting on new ones, and also caused the patient a great deal of discontinue by the tension on the joints and skin.
 !, By the nall extension method, the ) tension is made upon. the bones direct, and as such is the case, the correct amount of weights can be determined
 - - - -