Luxitions Bones of the Inferi ties. 378 For reduction, the patient fhould be laid on a mattress on the found fide, and a wooden roller covered with feveral folds of flannel placed between his thighs, and fixed firmly ar Extre ni- by ftraps to the wall. A ftrong bandage of buff leather, or fomething fimilar, fhould be applied to the under end of the thigh, with ftraps fixed to it to make the extenfion. The Method of trunk of the body should be properly fecured, and the joint reduction. of the knee bent. The extenfion should be made at firft gently, and increafed gradually, while, at the fame time, the thigh is made to roll in different directions. When the extention is fufficient, two affillants should lay hold of the roller, and attempt to raise the bone; the extending force fhould then be flackened, and the furgeon fhould push the head of the bone upwards and outwards, while an affistant preffes the knee forcibly inwards. The muscles themselves will then commonly bring the bone into its place; and this is done with such a jerk and noise, that it is heard by the byftanders. If the reduction be not obtained, the extenfion must be repeated with greater force. Inftead of the roller a broad strap or table cloth is frequently ufed. The limb should not be used for some time after reduction, and inflammation should be prevented by the proper remedies. 379 Lexation tella. The patella can neither be luxated upwards or downof the pa- wards, without rupture of the tendons of the extenfors mufcles, or of the ftrong ligament which fixes it to the tibia; but it may be luxated to either fide. The luxation produces lameness, and much pain on attempting to move the joint. In recent cafes the injury is eafily difcovered; but when the furgeon is not called immediately, the fwelling may be fo great as to render it more difficult. For reduction, the limb should be kept extended; the furgeon, by depreffing the edge of the patella moft diftant from the joint, is enabled to raife the other, and push the bone into its place. 380 Luxation at the knee. It may be neceffary to remain a day or two in bed till the knee recover its tone. Sometimes, after the bone has been difplaced, returns of the fame complaint become frequent. In fuch cafes, proper machinery applied to the fide of the tumor, where the bone is apt to start out, is used with advantage. From the fize of the joint, and the great ftrength of the of the tibia ligaments, luxations of the tibia from the os femoris rarely occur. When it does, it is easily discovered by the pain, lameness, and deformity of the limb. The patient thould he laid on a table, the muscles relaxed, and the thigh secured by affistants; the limb fhould then be extended, and the bones cleared of each other, when they will be easily replaced. After the reduction, the limb fhould remain for fome time perfectly at reft; and inflammation, which is very apt to enfue, and is attended with very bad confequences, should be affiduously guarded against. 3SI Luxation of the ankle-joint. If the ankle joint be dislocated forwards, the fore part of the foot is lengthened; if backwards, the foot is fhortened and the heel lengthened (this is the most common variety); if to either fide, there is an uncommon vacancy on the one fide, and a prominency on the other. Diffocation, however, can hardly take place outwardly without fracture of the end of the fibula. For reduction, the limb fhould be firmly held by affiftants, the muscles relaxed, and extenfion made till the bones are cleared of each other, when the aftragulus will eafily flip into its place.-The fame rules fhould be obferved in reducing diffocations of the bones of the foot. Luxations of the metatarsal bones and toes are reduced exactly in the fame manner as the bones of the metacarpus and fingers. CHAP. XXXII. Of Fractures. SECT. 1. Of Fractures in general. THE term frature is generally confined to fuch divifions in bones as are produced by external injury. When the integuments remain found, the fracture is called fimple; when it communicates with a wound, it is called compound. in general. ture. 382 The general symptoms of fracture are pain, fwelling, and Symptoms tenfion in the contiguous parts. A grating noife when the of frac part is handled, diftortion, and a certain degree of lofs of power in the injured part, accompany almost every fra&ture, except when it runs longitudinally, and the divided parts are not completely separated from each other. When there is only a fingle bone in a limb, a fracture is eafily detected; but where only one of two bones of a limb has fuffered, it is often difficult to judge with certainty, especially if the contiguous foft parts be tenfe and painful before the practitioner is called. In that cafe, the opinion must be regulated, not only by the attendant fymptoms, but, ift, By the age and habit of the patient; for bones are more easily fractured in old than in young perfons. Different diseases, too, induce brittleness of the bones, as the lues venerea and fea-fcurvy. 2d, By the fituation of the part; for bones aremore apt to be fractured in the folid parts of their bodies. than towards their extremities, where they are more foft and pliant. 3d, By the pofture of the limb; for a weight may fracture a bone lying on an unequal furface, which it would have futained without injury if equally fupported. Fractures are fometimes attended with a great degree of echymofis, occafioned by the ends of the fractured bones wounding fome of the contiguous blood-veffels. 383 In giving a prognofs of fracture, various circumftances Prognosis. are to be attended to. It is evident that fmall fractured bones are more cafily healed than large ones, and that the fracture of the middle of a bone is not near so dangerous as near the extremity. A cure is effected much more readily in youth than in old age, and in good conftitutions than in bad. We ought alfo to attend to the concomitant symptoms, and the injury which the neighbouring parts may have fuftained. The more moderate the symptoms, the more favourable our prognofis may be. 384 The treatment of fractures confift of three particulars; Treatment. replacement, retention, and obviating bad fymptoms. 1. When bones are fractured directly across the parts, they are often very little moved from their natural fituation; but when the fracture is oblique, they are apt to pass over each other, and to produce much uneafmefs and deformity; the contiguous muscles are severely injured, and the pain is aggravated by the flightest motion. The furgeon fhould put the limb into the best posture for relaxing all the muscles connected with it, according to the practice first introduced by Mr Pott. If it be properly attended to, the ends of the bones will in general be easily replaced. When any difficulty occurs, a smal degree of extenfion may be made, taking care to keep the muscles as relaxed as poffible. Much attention should be paid to replacing the bones properly, otherwife the limb will remain for ever after diflorted. 2. After the bones are replaced, the limb fhould be laid in the cafieft pofture, and the bones afterwards retained. in their fituation by proper compreffes and bandages, not applied too tightly, till the cure be completed. The time neceflary for this purpofe depends on the fize of the bone, the age and habit of the patient, the fteadiness with which the limb has been retained in its place, and the violence of the Fractures the attending fymptome. In middle-aged perfons, and unin general, der favourable circumstances, a fracture of the thigh bone, or of the bones of the leg, may be cured in two months; of the arm bone, or bones of the fore arm, in fix weeks; of the ribs, clavicles, and bones of the hand, in three weeks. In infancy the cure will take a fhorter, and in old age a longer, time than this. 3. In fimple fractures the inflammatory fymptoms gene. rally subside in a few days. When they become worse, which is fometimes the cafe, aftringent applications fhould be employed. If thefe fail, blood ought to be drawn from the parts affected. This is of fo much advantage, that it ought never to be omitted where the furrounding foft parts are much injured. Friction with emollient oils, warm bathing, the use of Bath and other fimilar waters, are alfo of much fervice. The limb fometimes puts on a clumsy appearance from an overgrowth of callus. When this tendency appears, ardent fpirits and other aftringents are confidered as useful; fometimes preffure on the part by a thin plate of lead fixed by a bandage may be advantageous. Many inftances occur, however, where no remedies prove fuccefsful: The patient ought therefore to be acquainted beforehand with the probable event, to prevent unpleasant reflections afterwards. 385 Fracture of the nose. Sometimes the ends of the bone remain loofe long after they might have been reunited. This may be owing to fome conftitutional difeafe, to the bones not being kept fteadily in contact, to fome of the foft parts getting in between them, or to the bone being broken in different places, and the intermediate fractures being too fmall to adhere. Pregnancy has also been mentioned as a caufe. By removing these obstructions, a perfect union may in recent cafes be accomplished. But where the cafe is of long stand. ing, callus of the bones becomes fo hard and fmooth as to move with the ease of a joint, fo that no advantage can be derived from laying them together. In that case, an incifion fhould be made through the foft parts, and a small portion of the ends of the bone removed with a faw. If this be properly performed, nature will fupply the deficiency. When Imall pieces of bone remain long loose, they fhould be extracted by making an opening. The intervention of muscles or other foft parts is known by the very fevere pain and tenfion, and by particular motions of the limb cauling great pain and twitching of the muscles which move it. The limb fhould be put into all the variety of fituation; and if this does not fucceed, an opening must be made, and the foft parts removed. Sometimes in fractures blood-veffels are ruptured by the sharp fpicule of the bone: this happens moft commonly in compound fractures. When the effufion of blood is great, the part fwells fo much that it is necef. fary to lay it open, and to fecure the divided veffels by a ligature. When the fwelling is not great, the absorption of the blood is trufted to nature. When the blood remains long in contact with the fractured bone, it fometimes prevents the formation of callus; the periofteum feparates from a confiderable portion of the bone, and a thin fetid fanies is difcharged at the wound. When this happens, no cure can be expected till the parts of the bone deprived of periofteum have exfoliated, or have been feparated by a faw. vicles, Ribs, milar inftrument. If any portion be almoft entirely fepara. Fractures ted from the rest, it should be removed; but if it adheres of the Cla. with confiderable firmness, it is to be replaced. If the bones, after being replaced, do not remain in their proper and Spite. Sternum, fituation, they are to be retained either by, tubes introduced into the nostrils, or by a double-headed roller, with probe prevented by the proper remedies. per compreffès as the cafe may require. Inflammation should Much care-is neceffary in replacing the fractured bones of the face, and in dreffing them, in order to prevent defor mity. The dreffings may be retained by adhefive plafters. Inflammation, by which the eyes, nofe, or antrum maxillare is apt to be injured, should be prevented. When matter collects in the antrum, it is to be removed by the methods formerly defcribed. 386 For replacing fractures of the lower jaw, the patient Fractures fhould be feated in a proper light, with his head firmly fe. of the low. cured. The furgeon fhould prefs with one hand on the iner jaw. fide of the bone, while with the other he guards against inequalities on the outfide. If a tooth come in the way, it fhould be extracted; when any of the others are forced out of their fockets, they fhould be replaced, and tied to the neighbouring teeth till they become firm. The fractured parts being kept firm by an affiftant, a thick comprefs of linen or cotton fhould be laid over the chin, and made to extend from ear to ear over it; a four-headed roller fhould be applied firm enough to keep the fractured parts in contact. The patient fhould be kept quiet during the cure, and fed upon fpoon-meat. The dreffings fhould be removed as feldom as poffible. When the fracture is accompanied with an external wound, the parts fhould be fupported by an affiftant during the dreffing of it. ́SECT. III. Fractures of the Clavicles, Ribs, Sternum, and Spine. 387 A FRACTURE of the clavicle is easily discovered by the Fracture grating noise in the fractured bone upon moving the arm of the cla freely, by the ends of the bone yielding to preffure, and by vicle. the motion of the humerus being impeded. All that can be done is to raise the arm, and fupport it at a proper height, either by a fling, or, which is better, by the leather cafe recommended in cafe of luxation of this bone. By this the fractured parts will be brought together, fo far at lealt as to prevent deformity, and render the bone fufficiently ftrong. 388 Fractures of the ribs are difcovered by preffures with the of the ribs. fingers. The fymptoms are commonly moderate, and the patient foon gets well. In fome cafés, however, the pain is fevere, the breathing becomes difficult, attended with cough, and perhaps with fpitting of blood, and the pulle is quick, full, and fometimes oppreffed. Thefe fymptoms arile from the ribs being heat in on the lungs. In the treatment, it is proper in every cafe to discharge fome blood. If one end of the rib rife, it ought to be repreffed by moderate preffure; and to prevent its rifing again, a broad leather belt should be applied pretty tight, and continued for fome weeks. When a portion of the rib is forced inwards, an opening fhould be made over it with a scal-pel, and then it fhould be elevated with the fingers or a for.ceps. When diftreffing fymptoms proceed from air or blood collected in the cavity of the cheft, thefe fluids ought to be difcharged by an operation. 389 SECT. II. Fractures of the Bones of the Face. FRACTURES of the nofe may impede refpiration, affect the speech and sense of smelling, give rile to polypi and te- The fymptoms of a fractured fternum are nearly the fame of the fter dious ulcers, and may befides be dangerous from their vi- with thofe of the ribs. It requires great attention from the num. cinity to the brain. When any part of the bones of the vicinity of the heart and large blood-veffels. The patient nofe has been raised above the relt, it is to be preffed into ought to lose a quantity of blood, and be kept on an antiits place with the fingers; if it has been pushed into the no- phlogistic regimen. If the pain, cough, and oppreffed breathtril, it is to be raised with the end of a spatula or other fi-ing, do not yield to these remedies, an incifion fhould be -made : Chap. XXXII. S U R G Fracture of made on the injured part, and the depreffed piece raised the Bones, with a levator. Should this be infufficient, it may be affected by means of the trepan: this indeed requires the greateft caution, but it may certainly be attended with advantage when the patient's lite is in danger. 390 Of he ver tebræ. 391 Fract ef Fractures of the vertebræ generally end fatally. We When any parts of the vertebræ near the integuments are THE fcapula is feldora fractured; when it is, the fracture the scaputa. is easily discovered by the pain, the immobility of the arm, and by the touch. The parts may be replaced with greater eafe if the muscles connected with them be relaxed. They are retained with difficulty. A long roller fhould be employed for this purpose, with which the head and fhoulders are alfo to be fupported. The arm should also be fufpended to relax the mufcles as much as poffible, and inflammation particularly guarded against by local bloodings. 392 Of the os Fractures of the humerus are easily discovered by the Lumei; pain, the immobility of the arm, and a grating noise on handling the parts. In reducing the fracture, the muscles fhould be completely relaxed by bending the arm and raifing it to a horizontal pasture. Extenfion, if neceffary, may be made by one affiftant grafping the arm between the fracture and the fhoulder, and another between the fracture and the elbow. After the reduction, one splint covered with flannel should be laid along the whole outside, and another along the whole infide of the arm; and then a flannel roller applied fufficiently tight to fupport the parts without in terrupting the circulation. The arm may either be fup. The arm may either be fup. ported in a fling or Mr Park's leather cafe, (fig. 104). The bandages should not be removed or feveral days, unless fome urgent symptoms render it neceffary. In about a week, howthe arm should be examined to lee whether the bones have been properly set. 393 Of the bones of the fore aim; ever, GER Y 395 Anchylofis, or stiffness of the joint, commonly fucceeds of the 395 In fractures of the metacarpal bones, a firm fplint fhould of he In 397 boue. SECT. V. Fra&ures of the Bones of the inferior Extremities. When both of the bones of the fore-arm are broken, the When the elecranum is fractured, the arm must be kept in an extended ftate during the cure, by applying a iplint oppofite to the joint of the elbow, reaching from the middle VOL. XVIII. Part I, The greatest difficulty is to retain the bones in their fitua- i 1 &c. the Bones, &c. 399 Fracture of the thigh. The fplints and bandages may be put on in the anxious, however, about bringing the pieces very close to- Fracture of the Bones, following manner: The patient being placed on a firm hair gether, as a cure may be made though they remain at a mattrefs, with his knee moderately bent, the long fplint ban- confiderable diftance. The bandages, unlefs particular lympdage and pillow are to be applied to the outside of the thigh, toms occur, fhould not be removed till the end of the fecond and the patient fhould be turned fomewhat towards the af- week; after which the joint fhould be cautiously bent every fected fide, with the knee and leg raised a little higher than fecond day to prevent ftiffness. the body: the short splint fhould then be applied along the infide of the thigh, and the bandage already placed without the other splint, applied fo tight as to make an equal moderate preffure over the whole (See fr. 106.). To make the part fill more fecure, it is proper to infert a long firm splint of timber under the middle of the pillow, and to fix it by two broad straps to the upper part of the limb. To prevent the limb from being affected by involuntary startings, the pillow fhould be fixed to the bed by straps: to keep off the weight of the bed-clothes, a frame with hoops fhould be placed over the thigh. The parts fhould be examined after some time to see that the bones be not difplaced. When there is pain, fwelling, and inflammation, leeches and other remedies should be applied. To render the fituation of the patient as eafy as poffible during the cure, he may be allow ed after the second week to turn a little more towards his back, and at the fame time to extend the joint of the knee in a small degree: after this time a little flexion and extenfion of the limb may be daily repeated to preserve the use of the joint. 398 Fracture tella. The method here defcribed generally fucceeds. Sometimes, however, notwithstanding all our care, the ends of the bone flip over each other. To prevent the deformity which this occafions, it has been attempted to make extenfion and counter-extenfion by machines: but the pain and irritation have always been fo great that little advantage has yet been derived from fuch means. The invention (fig. 107.) of the late Mr Gooch of Norwich, improved by the late Dr Aitken of Edinburgh, has been recommended as one of the best machines for oblique fractures of the thigh. After endeavouring to remove the pain, fwelling, and inflammation, which are sometimes fo great as to preclude the application of the fimpleft bandage, this machine may be tried. But if it be found impracticable to use it, the cure must be conducted in the usual way with the chance of the fractured pieces overlopping one another, and of courfe the limb being fomewhat fhortened. The patella is most frequently fractured tranfverfely, of the pa- fometimes lengthwile, and fometimes into feveral pieces. Fractures of this bone have been said commonly to end in a ftiff joint; but this is perhaps moft frequently owing to the limb being kept too long in an extended pofture. In the treatment of fractures of this bone, the leg fhould be extended to relax as much as poffible the foft parts connected with the bone. The patient fhould be placed on a firm mattress, and a splint be placed under the limb long enough to reach from the top of the thigh to the under end of the leg, to which the limb fhould be fixed by a number of ftraps to keep it in a state of extenfion. The fractured bones are then to be brought together, and fuch a number of leeches applied to the joint as will remove as much blood as the patient can bear; and as long as much pain and tenfion continue, faturnine and other aftringents are to be ufed for removing them. When this is accomplished, and the parts properly adjusted, a large pledget of Goulard's cerate fhould be laid over the joint, and a hooped frame employed to keep off the bed-clothes. In a longitudinal fracture the parts are easily kept together by a common uniting bandage or adhefive plafter; but in tranfverle fractures more force is neceffary. Various bandages have been employed for drawing the pieces together in fuch fractures; one of the beft of thele is, that represented fig, 108.. We need not be The leg is commonly fractured near the lower end, this Of the leg; If the patient be either very restless or troubled with spaf- 400 foot and Fractures of the bones of the foot and toes are treated Of the nearly in the fame manner as fractures of the hand and fin- bones of the gers. Befides the splint which may be neceffary for the tues. particular part,, a large one fhould be appled over the fole;. nor fhould any motion be allowed for a confiderable time either in the foot or ankle, otherwife the bones may be difplaced, and a proper cure prevented. SECT. VI. Of Compound Fractures. 401 By compound fracture is now generally meant a fracture Whether of a bone communicating with an external wound in the amputation integuments. They are much more dangerous than fimple hould be performed fractures. The generality of authors have confidered amin cafes of putation as indifpenfable in cafes of compound fractures ; compound while a few, particularly Mr Bilguer, furgeon-general to the fractures armies of the late king of Pruffia, affirm that it is fcarcely ever neceffary. Both feem to have carried matters too far. Some of the latest and best furgeons have recommended 8 Compound mended never to amputate immediately in private practice, Fractures. unless when the bones are so much shattered that they can. not reusite, or the texture of the foft parts completely deftroyed; because, even if amputation be at laft neceffary, the patient will have a greater chance of recovering than if it had been performed immediately after the accident: for the ftate of weakness to which he is generally reduced render the attendant symptoms lefs violent. On the other hand, it has been confidered as no bad rule in the army or navy, where patients cannot be kept in a proper fituation, and where fufficient attention cannot be given, to amputate immediately in cales of compound fractures of the large bones of the extremities. When amputation is not performed immediately, it is not, for several days at least, admiffible. It may afterwards be rendered neceffary by hemorrhagies, which cannot be stopped but by means more dangerous than amputation itfelf; by extenfive mortification; or by the ends of the frac tured bones remaining long difunited, while a great diicharge of matter endangers the patient's life. 402 of com pound frac tures. In treating compound fractures, all extraneous bodies Treatment fhould be removed, as alfo all thofe fmall pieces of bone which will probably not unite with the rest. For this purpole the opening, if neceffary, fhould be enlarged with a fcalpel. The next ftep is to replace the bones by relaxing the muscles as in fimple fractures. Sometimes part of a bone projects fo far through the integuments that it cannot be replaced without either fawing off the end of it, or enfarging the wound. If the fractured bone be long, fharp, and projecting much, it is best to saw it off; for though it were reduced, it would not readily reunite, and it would be apt to excite much pain and inflammation: But if it be broad at the bafe, and of no great length, it ought certainly to be fawed, even though it cannot be reduced without enlarging the wound. For the most part, it is only the fkin which it is neceffary to cut; but even the muscles ought to be divided, though as much as poffible in the direction of their fibres, when the bone cannot otherwise be replaced. After the reduction, a pledget of fome emollient ointment is to be laid over the wound, and the limb placed on a firm splint, and ftill kept in a relaxed pofture. In dreffing the wound, the limb ought not to be moved: the many tailed bandage, therefore, fhould be used rather than a roller. Various contrivances have been fallen upon to allow the limb to be at reft while the furgeon is dreffing it. The fracture box, invented by the late Mr Rae furgeon in Edinburgh, is one of the belt. When the leg is laid on this, it may be dreffed with tolerable facility without moving it. We are happy to have it in our power to announce to the gentlemen of the medical faculty, that another machine has lately been invented by Mr Samuel James furgeon in Hoddesden, Herts, which, we are told, will effectually relax the muicles, and retain the bones in their natural fituation, without pain to the patient or the leaft inconvenience to the operator. See fig. 110. Plate ccccxcn. It is of the greatest importance to prevent inflammation, which is apt either to produce mortification, or to give rife to extenfive absceffes. The dreffings fhould be removed once or twice daily according to the quantity of matter. The common application of warm poultices, on account of their inconvenience, may be deferred till they become neceffary by the approach of inflammation, which they are to be confidered as the fureft means of preventing by exciting a discharge of matter. Whenever the inflammation fubfides, and a free discharge of pus is produced, the poultices ought to be laid afide, left they do harm by relaxing the parts too much, and exciting too copious a difcharge. The fore ought then to be dreffed with mild aftringents, and the patient kept on a nourishing diet with tonic medicines. A free paffage should be given to the matter by putting the limb in a favourable posture, and by making a counter open- Distortions. ing, if neceffary, to the moft depending part. But this may be frequently avoided, by covering the fore with soft lint or fponge to abforb the matter. If the discharge become exceffive, and cannot be leffened by the means above-mentioned, it will be found to proceed from a portion of loole bone which has not been earlier noticed, by the removal of which it may be ftopt. If, inftead of producing matter, the inflammation terminate in gangrene, the danger is ftill greater than under the most extensive abfceffes. For the treatment of this, the reader is referred to Chap. III. Sect. 2d. CHAP. XXXIII. of Distortions. 403 DISTORTIONS of the bones may arise from external in- Caufes of juries, from diseased conftitutions, from a morbid ftate of the distortion. bones, or a contracted state of the muscles, or both; but the affection is most frequently owing to a weakly, delicate conftitution, as in rickety or fcrophulous cafes. 404 In the treatment of diftortions of the fpine, particular at-Treatment tention ought to be paid to the cause of the diforder. Ifof diftorit appear to arife from the patient continuing too long intion of the any particular posture, every habit of this kind fhould befpine. guarded against on the first appearance of the disease. If the patient has turned too much to one fide, the reverse of this should be advised. He ought to fleep upon a firm hair mattress, that his body may lie upon an equal furface. He fhould use an invigorating diet, the cold bath, bark, and other tonics. By a ftrict attention to the use of these remedies the disease has fometimes been retarded in its progrefs. Various machines have been invented for removing distortions of the spine by preffure; but confiderable caution is here required, otherwife much injury may arife from it. Some advantage, however, in certain cafes, has been derived from the use of the common collar (fig.'11.); or the stays and machinery adapted to them (fig. 112.), invented in France, and afterwards brought into use in this country by Mr Jones of London, are found to be ftill better fuited to this purpose. 405 The fame caules which produce distortions of the fpine of the may likewife produce diftortions of the limbs. Sometimes limbs. the distortion takes place with the original formation of the bones, at other times it occurs in infancy, and now and then at a more advanced period of life. In early infancy the bones are so pliable as to be readily affected by the postures of the body. When a child is too foon allowed to attempt to walk, its legs are apt to become crooked from their inabi lity to fupport the weight of the body. Certain difeafes likewife, efpecially rickets, fotten the bones fo much, that they yield to the polture of the body, and to the common action of their muscles. When the distortion of a limb is owing to a curvature in a bone, if the cafe be recent, and especially if it occur in childhood, it may frequently be removed, without mach difficulty, by making a gradual but conflant preffure, by the use of machinery, on the convex fide of the limb, till it recover its natural appearance. When the deformity occurs in the leg, a method has been used, in feveral inttances, which is to fix a firm fplint of iron, lined with leather, in the fhoe, on the concave fide of the leg, the other end of the fplint to reft againft the under end of the thigh; when, if a broad ftrap or two be applied round the leg and splint, an eafy gradual preffure may be made, and confiderable advantage derived from it. See fig. 113. Along with the curvature above mentioned, it commonly happens that the feet and ankles are affected. When the bones of the leg are bent outward, the fore part of the foot is turned inward, and the inner edge upwards; and the reverfe, if the leg be bent inward. In these cafes the affecZ 2 tions |