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Show riiAcrunn or THE new. on THE PERIOD or conrlnnnanr. side of the knee to the side of the foot. It must be made to receive the upper and lower heads of the fibula, and hollowed to receive the prominent muscles of the outside of the leg. Another splint, shorter than the last, is to be adapted to the then there is a stress upon the muscles of the leg; because the Achillis tendon is stretched. 148 plane surface of the tibia, on the inside. This splint should be straight, and reach only to the heads of the tibia. The fracture of the tibia is often of the worst kind. The tibia is weak, when we consider that the bone of one leg only, often sustains the u hole weight and shock of the body. Like the thigh hour, it is often broken obliquely, because it receives the shock of the body perpendicularly on its shaft; citizen but a worse circumstance in the state of this bone is, that it is i a.i iI". covered only by the thin integuments. These together, are the causes of the compound fracture of the tibia being so veg r}: frequent. They explain too, how a compound fracture, of any other bones, which are deeply imbedded in the soft parts, -'an be with so much more ease converted into simple fracture than that of the tibia, fix. because the bones can be with drawn from tire wounc", and the integuments healed so much .‘tn‘t - -<.. glu‘--.;x..i, ~.-. . more easily. In the treatment of the fracture of the bones of the leg, there is only one thing more to be noticed in the way of a ieading principle. I allude to the strength of the muscles of the leg, (muscles sulliciently strong to raise the weight of the 1429 When the heel is made to rest on the bed, care must be taken that the foot do not fall outward, else the tibia will be twisted, and there will be an irregular prominence of the broken bone, on the inside of the shin. OF THE PERKOD OF CONl‘IXEMENT. THE last observation I shall make, regarding fracture. oi the limbs, relates to the length of time which is necessary to the complete union of the bones. Different periods are pm scribed to us before it shall be permitted that: the patient should rise and use his limbs. Yet as far as I have been able. to judge, the period of confinement ought not to be dctermin ed, on the idea that there is any distinction in the commence ment or termination of the process of ossification in the smelt er and in the larger bone. The arm bone will unite as soon as the clavicle; and if the derangement of the surrounding parts, in the case of fractured thigh bone, be not much great or than in the fractured arm bone, the greater bone will be united as soon as the lesser. But in giving liberty to the patient, we should have regard to the use of the limb, and the stress to which the bone is to be exposed. And then, in- deed, a proper difference arises between the bones of the hole body) being on the back part only; and that innnedi arm, and those of the lower extremity; in the former, the ately on the accident, they are apt to cause the two pieces 0t bone to stand at such an angle as to thrust the broken ends ihrongh the 'ntegumcnts. When during the cure, the broken ends of the tibia arr made to project more and more at the shin, it is to be attribut~ (-d to the action of these muscles: and I conceive the best way of counteracting this, is to turn the limb, so that the bone bearing the weight of the limb only; in the latter, the bone sustaining the weight of the whole body and limb. The bandage around the fractured clavicle, may be eased before the expiration of the month; but the arm ought. not to be moved till the end of the month. Indeed the fractured humerus is not secure before the end heel may rest on the bed, while the toes are extended. This fully relaxes the muscles, while it gives the weight of the limb to counteract the curvature which is taking place. If the foot rests so that the toes are perpendicular to the heel, the fore arm. But we cannot allow the patient who has had a broken thigh bone, to rise till after the six weeks; and then he is of six weeks; and the same time is required for the bones of q» w." 'r? ., VtflNl 'MU ' I |
