or even in its complete destruction, results
towards which the concomitant injuries materially contribute. In many
instances where infection has occurred, ankylosis is the best result
that can be hoped for.

_Treatment._--As a rule, the first question that arises is whether
amputation is necessary or not, and the considerations that determine
this point are the same as in compound fractures (p. 26). If an
attempt is to be made to save the limb, the treatment is the same as
in compound fracture (p. 25).

#Dislocation complicated by Fracture.#--In certain dislocations the
separation of small portions of bones or of epiphyses is of common
occurrence--for example, fracture of the tip of the coronoid process
in dislocation of the elbow backwards, and chipping off of a portion
of the edge of the acetabulum in dislocation of the hip.

The most important example of a fracture complicating a dislocation is
fracture of the surgical neck of the humerus coexisting with
dislocation of the shoulder. Here the difficulty of diagnosis is
greatly increased, and the treatment of both injuries requires to be
modified. The dislocation must be reduced--by operation if
necessary--before the fracture is treated, and in many cases it is
advisable to secure the fragments of the broken bone by pegs, or
plates, to admit of movement being commenced early, and so to prevent
stiffness of the joint.

#Old-standing Dislocations.#--When, from want of recognition--and,
curiously enough, a dislocation is much more liable to be overlooked
than would have been thought possible--or from unsuccessful treatment,
a dislocation is left unreduced, changes take place in and around the
joint which render reduction increasingly difficult or impossible. The
rent in the capsule closes upon the neck of the bone, and fibrous
adhesions form between muscles, tendons, and other structures that
have been torn. The articular cartilage of the head, being no longer
in contact with an opposing cartilage, tends in time to be converted
into fibrous tissue, and may become adherent to other fibrous
structures in its vicinity. By pressing on adjacent structures it may
form for itself a new socket of dense fibrous tissue which in time
becomes lined with a secreting membrane. When the displaced head lies
against a bone, the continuous pressure produces a new osseous socket,
from the margins of which osteophytic outgrowths may spring, and as
the surrounding fibrous tissue becomes