Now the treatment embraces three principal indications. The first is to reduce the pieces of bone into their natural situation; the second is to secure and keep them in this state; and the third is to prevent any unpleasant symptoms likely to arise, and to relieve them if they do come on.

The first indication is only applicable to cases attended with displacement, for when the fragments are not out of their relative position, you must strictly refrain from all avoidable disturbance of the limb. Your interference should then be limited to putting up the fracture, resisting the accession of unfavourable symptoms, and removing them, if possible, after they have taken place.

The means then employed for the reduction of fractures in general are chiefly three, namely: - extension, counter-extension, and coaptation, or setting.

Extension signifies the act of pulling the broken part in a direction from the trunk, with the view of bringing the ends of the fracture into their natural situation. Counter-extension implies the act of making extension in the opposite direction, in order to hinder the limb, or even the body of the patient, from being drawn along by the extending power, which would then be unavailing.

Now, it is rather difficult to lay down rules respecting the precise degree of force which should be used in making an extension, for it must necessarily vary in different cases, according to the species of displacement, and the number and power of the muscles concerned in producing it. In transverse fractures displaced only according to the diameter of the bone a very moderate extension suffices, as it is merely practised with a view of lessening the friction and pressure of the surfaces of the fracture against one another.

But whatever be the direction of the fracture when the fragments pass over each other, the extension and counter-extension should be such as to remove the shortening of the limb and overcome the force of those muscles which, after all the attention has been paid to their relaxation, still oppose the reduction.

Now, extension ought never to be practised in a violent and sudden way, but in as gradual a manner as possible, the utmost care being taken not to shake or even move the limb any more than can be avoided, because when you extend a broken limb all at once violently you excite the muscles to strong spasmodic action, and there is some danger in lacerating them, for the reason that these fibres are not allowed the requisite time to yield to the force which elongates them. The extension is to begin, then, in the direction of the lower fragment, and be continued in that which is natural to the body of the bone.

In every case of fracture with displacement, as soon as the necessary extension has been made, you are now to endeavour to place the ends of the broken bone in their natural situation; this is termed coaptation, or setting. This operation is to be undertaken in different ways, according to the species of displacement, and you must execute it by acting upon the lower fragment, without applying your fingers to the fracture itself, in order to regulate the contact of the extremities of the bone. When, however, it is judged necessary for this purpose to touch the broken part itself, it should be done with the utmost gentleness, so as to avoid pressing the soft parts against the points and splinters of bone.

Although the reduction of fractures may in general be accomplished with tolerable facility, it sometimes happens that the first attempts fail This is occasionally ascribable to the employment of too much force and too little management in making the extension, whereby the muscles are irritated, and act so powerfully that the design is completely frustrated. Here the grand means of success is putting the limb into such a position as will relax the most powerful muscles which oppose the reduction; but the next question is, Can you maintain it? Sometimes, however, the irritable and convulsive state of the muscles is not the effect of any wrong mode of proceeding, but arises from the alarm, pain, and injury caused by the accident itself, the comminuted state of the bone, the irritation, or the very oblique direction of the fissure. But supposing the hone cannot be made to lie well at first, it will easily be made to do so in the course of a few days, when the tendency to spasm has diminished, and the pain and first irritation have subsided. Only watch and regulate the position of the limb about this period, and the cure will be completed in the most satisfactory way.

Now, after the bones have been put into their natural position, time alone would complete their cure, were there not in the muscles a continual propensity to displace the ends of the fracture again. This is one of the most gigantic difficulties that beset the recovery in the horse, because in cases of fracture the muscles are affected with involuntary spasmodic action, by which the broken parts are again displaced. Hence the absolute necessity of fixing the broken limb so effectually that it may continue perfectly motionless during the whole time requisite for the union of the fracture. The means employed for the fulfilment of this indication are an advantageous position, quietude, starch bandages, splints, and various kinds of apparatus. These can be had recourse to in the dog with success, but in the horse and cow the best appliances are defeated. Regarding splints, they are generally made of pasteboard, wood, or some resisting kind of stuff, and are applied lengthways on the broken limb, in some cases three, in others four, for the more steady and quiet detention of the fracture. Over these, then, you apply a dry bandage, and over this again another starch one, always remembering to proceed right to the toes, so that the circulation might not be arrested at the extremity, for should this occur death of the foot would he the sequel; therefore it is important to bear this

That splints, properly made and judiciously applied, are very serviceable, is beyond all doubt, but their utility depends upon their size, and the manner in which they are applied.

The true and proper use of splints is to preserve steadiness in the whole, limb, without compressing the fracture at all. By the former they become very assistant to the curative intention; by the latter they are very capable of causing pain and other inconvenience. At the same time they cannot, in the nature of things, contribute to the steadiness of the limb; therefore, in order to be of any real use at all, splints should reach above the knee, and below the fetlock. They should be so guarded with tow, rag, or cotton, that they should press only on the joints, and not at all on the fracture. By this they become really serviceable. But a short splint, which extends only a little above and a little below the fracture, and does not take in the two joints, is an absurdity, and, what is worse, it is a mischievous remedy; because, if we consider the principles on which the mechanical means operate usefully in the treatment of fractures, we shall find that they are various. For the most part they have this effect by holding the ends of the fracture steadily in contact, maintaining the proper length of the limb, and hindering motion, not only of the broken bone itself, but of the joints connected with it, without which object being fulfilled the fracture must always be liable to hurtful disturbance.

When a fracture is well set, the position of the part right, and the bandages and splints neither too tight nor too slack, the less the broken bone is moved, and the less the apparatus and dressings are disturbed, the better. Sometimes, however, you are obliged to take off the splints and undo the bandage in order to ascertain that the ends of the fracture lie in even contact. Were you to leave the splints or the starch bandages on the part too long, without ever being sure of this important point, you might find, when too late for alteration, that the fracture was in a state of displacement, and the limb seriously deformed.

Now all fractures, however simple and well treated they may be, are constantly followed by weakness and stiffness of the limb. These unpleasant consequences are the greater the more violently the limb has been contused, the nearer the fracture is to a joint, and the longer the part has remained motionless and without exercise. Again, the stiffness always affects the inferior joint of the broken bone much more than the superior. For the relief of these effects of fractures it is customary (or at all events it ought to be) to employ friction, liniments, emollient applications, cold water, etc. Still, notwithstanding such remedies, the leg does not quickly recover its strength, but often continues weak for a long time, as evinced when in running the dog will carry the injured limb instead of putting it to the ground. The most effectual plans for the prevention of this state should therefore be resorted to early. These consist in exerting the joints nearest the fracture, causing slight motions as soon as the union is sufficiently advanced not to be in danger from this practice. A great deal of caution, however, is necessary in moving the part, therefore it is safer for the veterinary surgeon to superintend the business than leave it to others. One of the best proceedings also for the prevention of much weakness and stiffness in the limb after a fracture, is to discontinue the splints or tight bandages immediately the state of the callus will allow. The manner in which their pressure retards the circulation, and prevents the action of the muscles, is one of the principal causes of the stiffness of the limb, and consequently the sooner they can be safely left off, the sooner will the patient regain the free use of the limb.

Again, fractures are always attended with a certain degree of contusion, which is constantly more severe in cases where the violence has acted directly on the situation of the fracture. But such contusion can only be regarded as a complication of the accident when it exists in so violent a degree as to demand a different treatment from that which is employed in simple fractures.

In this circumstance the splints and bandages should be applied rather slackly, and the latter ought to be wet with cold water. The next day the splints and bandages should be opened, a thing highly necessary to be observed, for whereat has been neglected the limb has been known to mortify in consequence of the swelling having rendered the bandage too tight. In conclusion then, three local circumstances are necessary to obtain a firm callus without deformity. Firstly, the two fragments must be possessed of sufficient vascularity. Secondly, the surfaces of the fracture must correspond. Thirdly, they must be kept in a completely motionless state.