It sometimes happens that when the case is an oblique fracture, the sharp end of the bone is so entangled in the adjacent muscles as to prevent a reunion; but if an incision is made upon them, and the point sawed off, they are easily replaced and readily unite. See Medical Musem, vol. ii. p. 404; Bell's Surgery, vol. vi. p. 79; White's Surgery, p. 143.

A fractured os innominatum. - In this case there is great danger, especially if the patient vomits a brown or bloody matter. In reducing it, the patient must lie on the sound side; the fractured parts must be restored by the surgeon's hands alone; then compresses, dipped in rectified spirit of wine, must be secured by means of the spica bandage. See White's Surgery, p. 143.

A fractured jaw. - When fractures of the upper jaw stretch towards the eyes, the consequent inflammation is often dangerous; and when they penetrate the antrum, they are generally tedious, and occasion great deformity. Replace the fractured bones with the fingers when there is no wound; or with forceps or a narrow scapula, when the parts are laid open; and a piece of adhesive plaster best retains the dressings. Bleeding, with an antiphlogistic regimen, must be advised to obviate inflammation of the eye and contiguous parts, and the reunion of fractured parts must be left to nature.

When the lower jaw is fractured, and its situation is ascertained, the bones must be carefully replaced; which is done by securing the patient's head, and pressing the fingers of one hand upon the inside of the jaw, while the other hand is employed externally in guarding against any perceptible inequality of the bone. If a tooth is seated in the course of the fracture, it must be immediately extracted; but if a tooth, not seated in the course of the fracture, is forced out of its socket, it may be replaced, and fixed by tying it to the contiguous firm teeth; the fractured bones must then be retained in a proper situation till they are firmly reunited, by means of a compress and bandage of soft old linen or cotton. The parts being kept firm by an assistant, a thick compress should be laid over the chin, and extended from ear to ear along each jaw; and, over the whole, a four-headed roller applied. Liquid diet is necessary until the cure is performed. See Bell's Surgery, vol. vi. p. 52,58; White's Surgery, p. 137.

A fractured metacarpus. - An assistant may extend the fractured hand upon a smoothtable, while the surgeon, with his fingers, endeavours to replace the fragments. White's Surgery, p. 145.

A fracture of the nose. - Both the bones and the cartilages are liable to be broken. If the bones are broken, the nose appears flat where the fracture is; but if the cartilage has suffered, the nose leans to one side. If the injury is considerable, the cure will be incomplete; and from the vicinity of this organ to the brain, the danger is considerable: an ozaena, a caries, or a polypus, may be the consequence. Fix the patient in a reclining posture, and elevate the depressed parts of the nose with a quill, replacing them in their proper order with the fore-finger and thumb of your other hand: to prevent their collapsing, fill the nostril with lint, or introduce a canula: if there is no wound, a plaster will secure the whole; but if there is a wound it must be treated in the usual way. If a splinter is so situated as to be reunited with difficulty, it may be removed. When the bones are reduced, they do not easily separate. Mr. Bell thinks, that any very loose portion of bone should be removed immediately, whether it be raised up or forced into the nostril; but whatever adheres to the remaining portion of bone, with firmness, should be replaced. See Bell's Surgery, vol. vi. p. 49.; White's Surgery, p. 137.

A fractured knee pan. - When a small fragment of the fractured patella is drawn upwards, if the patient is fat, it is not very easy to discover the accident. In examining to decide whether the patella is broken, the knee must not be bent, because the fragments are thus separated further from each other, and occasion unnecessary pain. This bone is generally broken transversely; the lower part remains fixed to the knee, but the upper is drawn by the muscles on the fore part of the thigh. When the case is discovered, the patient must be laid on his back, the leg extended, and the muscles above the fractured part gently pressed downwards, until the fragments of the bones approach within an inch of each other; in this situation they must be retained by a compress and bandage. The fractured parts should never be brought close together, for a stiff joint might in that way be occasioned.

Sometimes the ligament which secures the knee pan to the tibia is broken, and this case is mistaken for a fracture of the knee pan: the mistake is not of much consequence, as the method of cure is the same. See Warner's Cases of Surgery; Medical Museum, vol. iii. p. 349, &c; Bell's Surgery, vol vi. p. l l l; White's Surgery, p. 147.

Fracture in the foot. - Fractures in the tarsus, metatarsus, and toes, are generally accompanied with wounds, from the contusion of the nerves, tendons, ligaments, and membranes. They are cured in the same manner as those of the carpus, metacarpus, and fingers. Fractures in this part, as well as in the hand, and leg near the ankle, especially when the malleolus recedes from the principal bone, are seldom so completely cured as to leave the limb free from some inconvenience. Bell's Surgery, vol. vi. p. 130.

Fracture of the os sacrum and os coccyx - is discovered by the pain perceived in the part, and by the touch. The fragment must be reduced by the fingers; but if depressed inwardly, the fore finger must be introduced into the rectum, and the depressed part replaced. The T bandage should be then applied over a proper compress. The patient must keep his bed for two or three weeks; and when he turn6 from one side to the other, be cautious not to turn on his back: when he rises, the properest seat will be a chaise percee. See Bell's Surgery, vol. vi. p. 74; White's Surgery, p. 143.