Recent Fracture.—If the limb is in splints, they must be removed with care to avoid displacing the fragments ; the same precaution applies to sand-bags and bandages, if they are used.

When only one of the leg bones is fractured, the leg is sometimes supported only by sand-bags. If the tibia and fibula are both fractured, a back splint with foot-piece and side splints are used ; the side splints should not be allowed to drop off suddenly when bandages or straps are unfastened. The back splint had better not be removed for the first few days, and when it may be removed it is sufficient to draw it down only far enough to admit of giving passive movements to the ankle-joint ; the fracture is supported with one hand while the splint is being moved. Later on, when it is taken quite away and there is fairly firm union, the knee-joint is moved, the thigh is raised with one hand while the leg is pushed back with the other hand, which at the same time steadies the fracture; or the fracture may be made secure by putting on small side splints, to be removed when the exercises are finished.

The above remarks apply to fresh fractures — that is, from a few hours after the injury till union has taken place. The points for the masseuse to remember are, first, that she should not do too much ; effleurage is the only movement necessary for some time, done as gently, evenly, and lightly as possible, pressure being very gradually increased. Until experience teaches, it is difficult for a masseuse to believe that such light movements can be of so much use. After some days, kneading in whatever form it can best be accomplished, is added, also squeezing. Fulling and tapotement are not permissible.

The next point is care in readjusting the splints ; the heel and sole of foot must fit closely to the foot-piece of the back splint ; the side splints must also fit accurately. Massage is never anything but comforting and pleasant to patients with fractures, but needless pain may be caused by pressure of badly-adjusted splints or too tight bandages or straps.

The limb must be steadied with one hand while the work is done with the other. In passing over the fracture, raise the fingers at the distal side, and replace them at the proximal side, without interrupting the stroke, make a bridge, as it were, thus passing the fracture without touching it, and without a jerk : perfectly even work is of the greatest importance.

Massage is given immediately after a fracture to assist the absorption of blood which has been poured out by vessels in the neighbourhood having been ruptured, to prevent matting of soft parts, to prevent the formation of adhesions, to allay pain, to lesson muscular spasm, and to prevent muscle-wasting.

The toes in the case of a leg, and the fingers in the case of an arm, may be gently flexed and extended from the first