Whether the fracture be simple or compound, the method employed for the reposition of the broken fragments will be the same; but the presence of a wound, and maybe also the protrusion of a portion of the broken bone through the orifice, will give new and special features to the case which will require to be taken into account.

Where a fragment of bone protrudes through the skin, a very material difficulty is added to the operation of reducing the fracture, and serious injury may have been inflicted on muscles, nerves, and vessels in its course outward.

The protruding portion, which is usually the one uppermost, will require to be withdrawn into its proper position, and this will call for much force, great extension and counter-extension, and dexterous manipulation of the limb. If the projecting bone is considerable, its reposition by this means may fail, and the operator will be called upon to decide between two courses, viz., enlarging the opening, or sawing off a portion of the exposed bone. If the former is decided upon, the enlargement must be made in the direction of the axis of the bone, guarding as much as possible against the division of neighbouring vessels and nerves.

It may be that, notwithstanding this, complete return of the bone will be found impossible, in which case the protruding portion, or some part of it, must be removed by the saw. In carrying out this latter operation care must be taken to preserve the periosteum as far as possible.

Where the fracture is a comminuted one, some splinters of bone may be found to be completely torn away from the shaft and lying loose in the tissues of the part. These must be removed, and at the same time any shreds of broken fascia that may be met with. In the after treatment of the wound the antiseptic method must be strictly carried out. The hair for three or four inches round it should be removed. The wound must be freed from clotted blood by means of a sponge soaked in a five-per-cent solution of carbolic acid, and freely irrigated with the same solution.

A good pad of antiseptic gauze soaked in a three-per-cent carbolic solution should be applied over the wound and parts around, and over this a further succession of layers of dry antiseptic gauze, the whole being surrounded by a covering of thin mackintosh or some other impermeable material.

The wound will require to be dressed again some time in the course of twenty-four hours, according to the amount of exudation and saturation of the gauze. Another dressing will be necessary in forty-eight hours, after which the carbolic solution used should be reduced in strength to 1 in 40. Subsequent dressing must be made according to the state of the wound.

It will be understood that in the setting of the bone in compound fracture the wound must be left accessible for the purpose of dressing.