Fracture of the carpus. - These bones are small, and rarely broken; and when fractured, they cannot be properly replaced, nor will they consolidate. The ligament and tendons are also generally so much bruised, that the joint of the hand becomes rigid; abscesses, fistulas, and caries, generally ensue, and relief is seldom obtained but by amputation of the hand. An attempt may be made by two assistants extending, while the surgeon endeavours to replace the fractured bone or bones. White's Surgery, p. 145.

Fracture of the clavicle. - Whatever part of the clavicle is broken, the part which joins the scapula descends below that which is fixed to the sternum,.on account of the weight of the arm. When this bone is fractured, the patient cannot lift his arm; it hangs inclined toward his breast, and from a slight motion of the humerus, the fracture in the clavicle will be evident to the touch, sight, and ear. To reduce this fracture is easy, but to retain the bones in their proper situation more difficult. An assistant should place his knee between the scapulae of the patient, and with his two hands draw the shoulders back: the clavicles will be thus extended; and the surgeon, standing before the patient, must reduce the ends of the bone, by raising the arm to its proper situation, instead of loading the end next the sternum with compresses to bring down the rising end of the bone., A narrow but thick bolster is then to be applied above and below the clavicles, to fill up the cavities; upon these two narrow bolsters, in the form of the letter X, are to be laid; and over the whole a piece of thick paper moistened with vinegar. A wad of tow, or a ball made of soft rags, is put under the armpit, next to the fractured end, for the support of the shoulder; the bandage to keep the bones from moving, and a sling is fixed about the neck, to suspend the arm. See Bell's Surgery, vol. vi. p. 59. White's Surgery,p. 138. A fractured neck. - The processus dentatus of the second vertebra is tied to the skull by a ligament, and kept close to the fore-part of the first vertebra by another in that vertebra, that it may not bruise the spinal marrow; and when either this ligament or process is broken, it is styled a broken neck, whose consequence is sudden death.

Fracture of the ribs. - When the ribs are broken, their ends recede from each other; but when they project outward, no considerable danger ensues. If they press inward they produce an uneasy pricking, inflammation, cough, fever, an abscess, or spitting of blood. The cure is generally completed by applying an exact uniform circular compressive bandage, if neither inflammation veiling forbid: if these symptoms attend, they must be reduced by bleeding, etc.; then the bandage and a cooling diet will succeed. See Bell's Surgery, vol. vi. p. 63. White's Surgery, p. 140.

Fracture of the skull. - When, from an injury done to the head by external violence, a loss of speech and of sense, a lethargy, or convulsions follow, no certain conclusions can be made from these symptoms, as they may be owing to extravasation or concussion as well as to fracture. If, however, upon making an incision on the part, the pericranium is found loose, a fracture most probably taken place. In examining for a fracture, care is required to distinguish it from a suture, particularly the uncommon ones, as those about the ossa triquetra; but if, on scalping, we find the pericranium firmly adhering to any part that resembles a fracture, we may be assured that it is a suture. If, when the head is shaved, you can feel the pericranium under your finger to be loose, a fracture has clearly occurred.

When a fracture happens on the skull, the trepan is immediately used by some surgeons, with a view to obviate or prevent the effects of so great a degree of violence; but it is forbidden by the best practitioners, except a part of the skull is depressed. Celsus advises us not to proceed to an operation before the approach of unfavourable symptoms; and Ruysch adds, that"when the symptoms are not augmented, we are not to proceed to incision and perforation; but, after bleeding, we are to attempt the cure by repeated application of warm cephalic fomentations." The advice and practice of Mr. Bromfield, when a concussion of the brain happens, are of the same nature. See Concussio. White's Surgery, p. 211.

A fractured leg. - In the leg the tibia is generally fractured near its lower extremity, where it is weakest; and often, when the tibia is broken, the fibula is also fractured at its upper extremity. When there is a dislocation of the maleollusinternus, the fibula is commonly fractured, and has occasioned it.

A fractured fibula seldom gives any uneasiness, or hinders the patient from walking; but it may be discovered by taking hold of the leg under the calf with one hand, and with the other moving the foot; for the hand which holds the leg will distinguish the fracture. Mr. Pott thinks that, in this case, a tight bandage upon the fractured part is not to be admitted; but that, if it is applied to the two extremities of the leg, the broken end will be brought into contact, and a cure will be effected.

When the tibia is fractured, lay the patient on the injured side, on a flat surface, and raise the knee of the fractured limb towards the abdomen, at the same time bending the joint; thus the extensor muscles of the foot are relaxed, and the extension required for the reduction will be performed with ease. Having replaced the fractured bone, apply a long splint padded with tow to the fibula, and another on the inside of the leg, over part of the tibia, and secure them with straps. The patient may lie on the injured side during the cure, and thus a cradle or fracture box will be needless; the knee may also continue in the same posture as that in which the fracture was reduced.

If the tibia is fractured at its lower end by a gun shot, although the part above is apparently unhurt, the patient will lose his life unless the limb be taken off above the knee. Though if any other cause had produced a similar fracture, the operation below the knee would have succeeded. Bell's Surgery, vol. vi. p. 12 1. White's Surgery, p. 149.