Various kinds of fracture may be caused from a variety of causes, such as by a fall, pressure, blow, violent jerking or by the bites of ferocious beasts etc. These cases may be grouped under the two main subdivisions such as Sandhi-Muktam (dislocation) and Kánda-Bhagnam (fracture of a kánda). 2.

Cases of Sandhi-muktam (dislocation) may be divided into six different types, such as the Utplishtam, Vis-lishtam, Vivartitam, Adhah-Kshiptam, Ati-kshiptam and Tiryak-kshiptam. 3

General Features Of A Dislocation

Incapability of extension, flexion, movement, circumduction and rotation (immobility, considered in respect of the natural movements of the joint), of the dislocated limb, which becomes extremely painful and cannot bear the least touch. These are said to be the general symptoms of a dislocation. 4.

Diagnostic Symptoms Of A Dislocation

In case of a friction of a joint by two articular extremeties (Utplishtam) a swelling is found to appear on either side of the articulation attended with a variety of pain at night. A little swelling accompanied by a constant pain and disordered function of the dislocated joint, marks the case of simple-looseness (Vislishtam) of the articulation; while pain and unevenness of the joint owing to the displacement of the connected bones distinguish a case of Vivartitam (lateral displacement). An excruciating pain, and looseness of the dislocated bone arc the symptoms which characterise a case in which a dislodged bone is seen to drop or hang down from its joint (Adhah-kshiptam). In a case of abnormal projection (Ati-kshiptam), the dislocated bone is removed away from its joint which becomes extremely painful. A case of oblique dislocation (Tiryak-kshiptam) is marked by the projection or displacement of the bone on one side accompanied by a sort of intolerable pain. 5.

Different Kinds Of Kánda Bhagnam

Now we shall describe the Kánda-Bhagnam (fracture etc.). Fractures may be divided into twelve different kinds which are known as, Karkatakam, As'va-karnam Churnitam,Pichchitam,Asthi-chchalitam, Kánda-bhagnam, Majjágatam, Atipátitam, Vakram, Chchinnam, Pátitam and Sphutitam. 6.

General Symptoms Of Kánda-Bhagnam

A violent swelling (about the seat of fracture) with throbbings or pulsations, abnormality in the position (of the fractured limb), which cannot bear the least touch, crepitus under pressure, a looseness or dropping of the limb, the presence of a variety of pain and a sense of discomfort in all positions are the indications which generally mark all kinds of fracture (Kánda-bhagnam). 7. Diagnostic Symptoms: - The case where a fractured bone, pressed or bent down at its two articular extremities, bulges out at the middle so as to resemble the shape of a knot (Granthi), is called Karkatam. The case where the fractured bone projects upward like the ear of a horse is called As'vakarnam. The fractured bone is found to be shattered into fragments in a case of the Churuitam or comminuted kind which can be detected both by palpation and crepitation. A smashed condition of the fractured bone marks a case of the Pichchitam kind which is often found to be marked by a great swelling. The case where the covering or skin of the bone (periosteum) is cast or splintered off is called the Asthi-chchallitam. The case where the completely broken or severed bones are found to project through the local skin, is called Kanda-bhagnam (compound). The case where a fragment of the fractured or broken bone is found to pierce into the bone and dig out the marrow, is called Majjánugatam, (Impacted fracture). The case where the fractured bone droops or hangs down is called Ati-pátitam. The case where the unloosened bone (from its position) is bent down in the form of an arch is called Vakram The case where only one articular extremity of the bone is severed is called Chhinnan. The case where the bone is slightly fractured and pierced with a large number of holes, is called Pátitam, an excruciating pain being the leading indication. The case where the bone largely cracked and swollen becomes painful as if stuffed with the bristles of a Suka insect is called Sphutitam (Green-stick fracture). Of the several kinds of fracture, cures are effected with extreme difficulty in a case of the Churnitam, Chhinnam, Ati-pátitam or Majjánugatam kind. A case of displacement or laxation occurring in a child or in an old or weak patient or in one suffer-ing from asthma (Svasa) or from any cutaneous affection (Kushtha) or Kshata-Kshina disease is difficult to cure. 8.

Memorable Verses

The following cases are to be given up as hopeless - vis. fracture of the pelvic bone (or of bones that are of this description, wherever they may be situated); dislocation of the pelvic joints; compound fracture of the thigh bone or of the flat bones); fracture into small pieces of the frontal bone or its dislocation ; simple fracture of the breast-bones, back-bone and temporal and cranial bones. If the dislocations and fractures be improperly set from the outset (Adito) * or if the union be anyhow disturbed there is no hope for recovery. 9-11.

If fractures happen at any time of the first three stages of adult life which has been described before (vide Sutrasthána Chap. XXXV.) and if they are set up by an able surgeon they have a great chance of being united. 12.

A bending of a gristle or cartilage (Taruna) is called its fracture. A Nalaka (long bone) bone is usually found to be severed. A Kapála bone is found to be cracked, while a Ruchaka † (tooth) is found to be splintered off. 13.

* The word Adito may be taken into the sense of congenital malformation which is beyond remedy.

† The presence of the particle 'cha' denotes Valya-asthi

Thus ends the fifteenth Chapter of the Nidána Sthánam in the Sus'ruta amhitá which treats of the Nidánam of dislocations and fractures.