The Cordova daily times., 1917-03-14
DR. COUNCIL ON. TREATMENT OF
 FRACTURES

Copper River & Northwestern rail way, contributes the following inter- esting paper to the Alaska Medical Association Quarterly Bulletin on the general treatment of fractures:
 It is not the purpose of this paper to advocate any special method for the treatment of all fractures, but to try and give you some of the methods with which I have had the most sue cess.
 The amount of discussion and con troversy since Lane first advocated the open method continues unabated, and the end is not in sight. Some ad- vocate open operations for all frac lures, and others the closed method for practically all.
 l shall not take up the relative mer- its of the different materials used as gratis and splints, nor will I discuss the pros and cons of the supposed bone forming cells and tissues, but will confine myself to the diagnosis and the mechanics of reduction and immobilization of fractures, the long bones principally of the lower extremi- ties.
 There are two results which the bone-setter must strive for: First, a good functional result, and second, good anatomical result. Old Dame Nature is a wonder worker when it comes to bone repair, and have seen many case where a good functional result had been obtained, but if a ski agraph of same was shown to a jury sitting on a personal injury suit they would award all that was asked for. Of patients admitted to the hospital here for treatment from 1909 to 1916 (2,240 in number) 123, or 1-2 per cent have been suits for personal in- jury against the different companies or corporations patronizing the hospital here, practically 100 per cent were fracture cases. The burden of large number of fracture cases will fall up on the doctor accepting contract work in Alaska, and will continue for years to come, or as long as Alaska is in the development stage. Inasmuch as this is the case, he must be well equipped for such work If a develop ment company or corporation furnish es the equipment, the amount saved by the proper treatment of even one case might furnish all the equipment necessary.
 By equipment mean, first of all a good X-ray outfit, and second, the pro per instruments, such as chisels, saws, drills, plates. screws, splints, etc. The doctor himself must have good equip ment, i. e., thorough knowledge of anatomy mechanical skill and per feet surgical technique coupled with sound judgment. These are essential things.
 When a fracture is suspected a ski agraph should always be taken where possible. I have seen quite number of cases show a fracture where none could be determined by palpation or manipulation and the nature of the injury determined. If 1t is simple transverse fracture and there is no great amount of confusion or swelling, the patient should be anesthetized to complete relaxation, and the limb ma nipulated until the ends are in appo- sition, which can be determined by gently pushing the distal ends toward the body. When the ends seem to be in good opposition the patient is al lowed to partially regain conscious ness. Muscular contraction will then aid in keeping the ends in opposition while the cast or splints are applied AS an immobilization apparatus plaster paris in proper hands has no rival. It and as any splint or immobilization apparatus, to be effective, must ex- tend beyond the joints next above and below the seat of fracture, no other form of splint can be made to fit as snugly and be so comfortable for the patient. A skiagraph is now taken through the cast and result of the work determined. If you have gotten three-quarter anatomical alignment of the fragments you can be assured of good result. A picture should be made each week up to three weeks tC determine if there has been any later movements of the fragmnts.
 This method is not applicable tc fractures in the lower nor the upper third of the femur. So much for sim pie transverse fractures.
 If your plate shows an oblique ol spiral fracture and you have compe tent assistance, and the condition o your patient is good, an open opera ton and fixation is the method o choice. Here, to assure success, ths asepsis must be perfect The entire limb is gone over with benzine and by tinctcre of iodine, which is allowed to thoroughly dry. then remove thu surplus iodine over the surface tt be incised with alcohol or ether. Tn, limb and patient are covered with ster .,on,a toua1o ar ohooto TWO kpivo,