ght angle, and the forearm supported in a sling midway between
pronation and supination. For a few days the limb may be bound to the
chest by a broad roller bandage.

[Illustration: FIG. 31.--"Cock-up" Splint, for maintaining
Dorsiflexion at Wrist.]

The splints are removed daily to admit of massage and movement being
carried out, and while the splints are off, the patient is allowed to
exercise the fingers and wrist. If at the end of four or five weeks,
osseous union has not occurred, the reparative process may be hastened
by inducing venous congestion by Bier's method.

In _oblique and spiral_ fractures it is often necessary to control the
shoulder and elbow-joints to prevent re-displacement. This can be done
by means of a plaster of Paris case enclosing the upper part of the
thorax, together with the upper arm, abducted, and the elbow, at right
angles.

[Illustration: FIG. 32.--Gooch Splints for Fracture of Shaft of
Humerus; and Rectangular Splint to secure Elbow.]

It is sometimes necessary to apply continuous extension to the lower
fragment to prevent overriding. For this purpose a Thomas' arm splint
is employed, the extension tapes being attached to its lower end, but
care must be taken that the traction is not sufficient to separate
the fragments and leave a gap between them. The elbow should not be
retained in the extended position for more than three weeks.

In rare cases it is necessary to have recourse to operative treatment.

When there is evidence that the radial nerve has been injured, and no
sign of improvement appears within three or four days of the accident,
operative interference is indicated. An incision is made on the
lateral side of the arm, and the nerve exposed and freed from
pressure, or stitched, as may be necessary; the opportunity should
also be taken of dealing with the fracture. The limb is put up in a
"cock-up" splint, with the hand in the attitude of marked dorsiflexion
(Fig. 31).

Satisfactory results have been obtained without the use of splints, by
relying upon massage to overcome the spasm of muscles, and allowing
the weight of the arm to act as an extending force (J. W. Dowden and
A. Pirie Watson).

In cases of _un-united fracture_, a vertical or semilunar incision is
made over the lateral aspect of the bone, and the muscles separated
from one another till the fracture is exposed, care being taken to
avoid injuring the radial nerve. The fibrous tissue is removed from
the