Licence: Public Domain Mark
Credit: Outlines of human pathology / by Herbert Mayo. Source: Wellcome Collection.
Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.
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![b. The ends of a broken bone must be kept in proper apposition, or the limb, if union take place, will be perma- nently shortened, or bent, or twisted, or all three together. The cause, which tends to displace the ends of a broken bone, is the action of muscles. In general the effect of muscular action on a broken limb is to shorten it, causing the bones to ride, or even to meet at an angle, as in fractures of the clavicle and of the bones of the extremities, [c. 33.] In certain cases, however, the portions of the broken bone are drawn asunder by the muscles, as in transverse fractures of the patella and of the olecranon; and (although upon a different principle) in fractures of the lower jaw. [g. 7. g. 8. g. 9.] In other cases the bones are in danger of uniting twisted. When the radius is broken, the muscles have a tendency to supinate the upper part, and to pronate the lower. In frac- tures of the thigh and leg, the upper part of the limb is always rotated inwards by the action of the muscles j while the lower part has a disposition to fall outwards. In producing artificial extension of a limb, it must be re- membered that the means which are employed stretch the joints as well as the fracture. A broken limb, when set, should therefore be longer than the sound one. c. The same means, which maintain a broken limb of the right length and direction, serve to keep it at rest. How soon, upon pathological principles, should these means be applied ? As far as the condition of the fracture is concerned, the appli- cation of splints, or the operation of setting, is not requisite till the fourth day. But, upon other grounds, it is expe- dient to set a limb at once. The muscles, when no longer kept in extension, contract and shorten; and it is often found difficult, at the expiration of four or five days, to restore the limb to the length which it may have lost through not being set at once. It is true, indeed, that a fractured limb is often so swollen, that splints cannot be applied. In that case the swelling serves the same purpose, and keeps the limb on the stretch. It deserves likewise to be stated, that fractures unattended with swelling occa- sionally go on best, when nothing is done but laying the](https://iiif.wellcomecollection.org/image/b21066735_0042.jp2/full/800%2C/0/default.jpg)
