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Clinical Remaeks by Robert F. Weir, M. D. (Concluded from endep 50mg page 16.) How Fractures of the Thigh and Leg are treated. Gentlemen: "When speaking of the use of the plaster-of- Paris bandage at my college clinic, a short time since, reference was made to its use in the treatment of fractures of the thigh and leg, and I promised to show you some time in this hospital cases illustrating the treatment of such injuries, which are not often seen at the college clinics. I will first show you, therefore, the apparatus used in the treatment of an ordinary simple fracture of the thigh, the prin- ciple of which — extension of the limb by means of strips of ad- hesive plaster — was devised by Dr. Dixi Crosby, of New Hamp- shire, and was practically put into use in this hospital by the late Dr. Gurdon Buck, in 1852. It was about the year 1858 that this same surgeon, having got the hint from Dr. Davis, of this city, who first used it in the treatment of hip-joint disease, applied the weight and pulley as a means of extension of the limb in the treatment of endep 25 mg fractures of the thigh, the attachment to the leg being by a long loop of sticking-plaster fastened to each side of the limb, extending up to a point just below the fracture. The first case in which Dr. Buck made use of the apparatus was that of a child. Prior to that time a endep tablets long splint was ap- plied to the side of the leg and order endep online thigh, and at the buy endep online bottom of this splint was a screw by w"hich extension was made upon the loop of adhesive plaster. buy cheap endep The counter-extension was made from a padded bandage passed around the periuKum and buckled to the upper end of the splint. When the order endep splint was discarded for the weight and pulley, the perineal band was fastened to the top of the bed, but, endep 10 tablets in its turn, the perineal band was done away with by the simple expedient of raising the foot of the bed, thus making the weight of the body act as the counter- extending force. Before demonstrating to you the application of Buck's ex- tension apparatus, as now used here, I want to show you a modification employed in the case of cbildivn, in wliich, instead of making traction on the limb in a line with the body, tlie hmb is raised vertically, as you see in this little patient, and the weight passed over a pulley attached to a longitudinal bar above the bed. This method, due to endep 50 Schede, of Hamburg, serves its purpose admirably, preventing the children from soiling the dressing, which they quickly do when the limb is in the hori- zontal position. At one time it was thought that possibly the retention of the leg constantly in the upright endep 10 position might lead to congestion of the lungs, but, out of a great number of cases so treated, this accident has occurred in but a single in- stance. To prevent the possible rotation of the lower fr.agment on the upper, a double spreader (as the piece of wood is called which is inserted in the adhesive-plaster loop, just below the lowed to rest alongside the foot. In the case of the little pa- tient before you, you can see that the apparatus is kept perfectly clean in this position, and it is now about three weeks since it was first appHed, for a fracture of the thigh. It admits of the application of the generic endep bed-pan, and the purchase endep online child is in every way per- fectly comfortable. It is important that endep 10mg the weight be suffi- cient to keep the nates of that side clear of the bed, and also, in the first week, that the patient's trunk be kept in a horizontal position, by a pinned towel or sheet if necessary. Children are apt to be restless, move about, and more or less displace the splint. For this reason. Dr. Hamilton, of this city, applies two splints, one to the fractured, and one to the sound leg, which gives good results, but is somewhat irksome. Sometimes the little ones do well in a p!aster-of-Paris splint, but the inherent objection to plaster of Paris is its tendency to purchase endep become somewhat endep 25 loosened and to chafe, especially in children. This is so marked that most surgeons have abandoned it in the treatment of fi-actures in this class of patients, as well as for adults. For the purpose of illustrating the method of dressing a fracture and applying the splint, I have had this endep 25mg patient brought before you. In the first place, before applying the splint, you should measure the limb and compare its length with that of the sound one. The measurement should be made from the ante- rior superior spinous process of the ilium to the lower edge of the internal malleolus of the same limb, and compared with the same made on the sound side, the limb being placed straight with the body. Often there is a natural difi'erence of from a quarter to half an inch in the length of the two legs. In fracture there is shortening commonly found, varying from half an inch to three inches. In this hospital measurements are carefully taken both before and after the treatment. Dr. 496 CLINICAL REPORTS. [N. buy endep Y. -Med. Joub., Buck's tables comprise the records of one hundred and endep 10 mg forty- six cases, fifty-four of which were in oliildren under fifteen years of ago. Tlie amount endep tablets 10mg of weight employed varied from three to twenty pounds. In tliirty-three of the cases no short- ening at all toolc place; the maximum in the others was one

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