The treatment of these injuries differs only from that of simple sprains in the following particulars: Although massage may be, and as a rule should be, commenced at once, rest for the part in splints of some kind must be maintained for a long enough period to enable the detached piece of bone to reunite sufficiently to retain its position during voluntary movements. Hence, as early movements are essential to quick recovery, these must be passive, and not voluntary, as in simple sprain. This is a most important point in the treatment in these cases, especially in connection with deformities following sprains - a matter with which I shall deal presently. The treatment of simple sprains may be tabulated thus: (1) Voluntary movement, (2) massage, (3) passive movement and exercises; whilst that of sprains with fracture would run: Massage, passive movement, voluntary movement and exercises ; the reason for the early use of passive rather than voluntary movements being obviously that the detached piece of bone is not disturbed during the use of passive movement if properly carried out; whereas, if voluntary movement were allowed, imperfect or faulty union would not improbably follow with the usual imperfect recovery.

These remarks apply only to cases in which there is a definite detachment of a portion of bone; they have no bearing upon cases of so-called 'sprain-fractures' in joints in which the cartilage is in part torn from the articular surface, the bone being involved in the lesion. The treatment of such cases, which are generally undiagnosed if they often occur, differs in no respect from that of simple sprains.