be slit open along the
seams.

The patient should be placed on a firm straw, horse-hair, or spring
mattress, stiffened in the case of fractures of the pelvis or lower
limbs by fracture-boards inserted beneath the mattress. Special
mattresses constructed in four pieces, to facilitate the nursing of
the patient, are sometimes used.

In many cases, particularly in muscular subjects, in restless
alcoholic patients, and in those who do not bear pain well, a general
anaesthetic is a valuable aid to the accurate setting of a fracture, as
well as a means of rendering the diagnosis more certain.

The procedure popularly known as "setting a fracture" consists in
restoring the displaced parts to their normal position as nearly as
possible, and is spoken of technically as the _reduction_ of the
fracture.

_The Reduction of Fractures._--In some cases the displacement may be
overcome by relaxing the muscles acting upon the fragments, and this
may be accomplished by the stroking movements of massage. In most
cases, however, it is necessary, after relaxing the muscles, to employ
_extension_, by making forcible but steady traction on the distal
fragment, while _counter-extension_ is exerted on the proximal one,
either by an assistant pulling upon that portion of the limb, or by
the weight of the patient's body. The fragments having been freed, and
any shortening of the limb corrected in this way, the broken ends are
moulded into position--a process termed _coaptation_.

The reduction of a recent greenstick fracture consists in forcibly
straightening the bend in the bone, and in some cases it is necessary
to render the fracture complete before this can be accomplished.

In selecting a means of retaining the fragments in position after
reduction, the various factors which tend to bring about
re-displacement must be taken into consideration, and appropriate
measures adopted to counteract each of these.

In addition to retaining the broken ends of the bone in apposition,
the after-treatment of a fracture involves the taking of steps to
promote the absorption of effused blood and serum, to maintain the
circulation through the injured parts, and to favour the repair of
damaged muscles and other soft tissues. Means must also be taken to
maintain the functional activity of the muscles of the damaged area,
to prevent the formation of adhesions in joints and tendon sheaths,
and generally to restore the function of the injured part.

_P