ractical Means of Effecting Retention--By Position._--It is often
found that only in one particular position can the fragments be made
to meet and remain in apposition--for example, the completely supine
position of the forearm in fracture of the radius just above the
insertion of the pronator teres. Again, in certain cases it is only by
relaxing particular groups of muscles that the displacement can be
undone--as, for instance, in fracture of the bones of the leg, or of
the femur immediately above the condyles, where flexion of the knee,
by relaxing the calf muscles, permits of reduction.

_Massage and Movement in the Treatment of
Fractures._--Lucas-Championniere, in 1886, first pointed out that a
certain amount of movement between the ends of a fractured bone
favours their union by promoting the formation of callus, and
advocated the treatment of fractures by massage and movement,
discarding almost entirely the use of splints and other
retentive appliances. We were early convinced by the teaching of
Lucas-Championniere, and have adopted his principles in fractures.

In the majority of cases the massage and movement are commenced at
once, but circumstances may necessitate their being deferred for a few
days. The measures adopted vary according to the seat and nature of
the fracture, but in general terms it may be stated that after the
fracture has been reduced, the ends of the broken bone are retained in
position, and gentle massage is applied by the surgeon or by a trained
masseur. The lubricant may either be a powder composed of equal parts
of talc and boracic acid, or an oily substance such as olive oil or
lanolin. The rubbing should never cause pain, but, on the contrary,
should relieve any pain that exists, as well as the muscular spasm
which is one of the most important causes of pain and of displacement
in recent fractures. The parts on the proximal side of the injured
area are first gently stroked upwards to empty the veins and
lymphatics, and to disperse the effused blood and serum. The process
is then applied to the swollen area, and gradually extended down over
the seat of the fracture and into the parts beyond. In this way the
circulation through the damaged segment of the limb is improved, the
veins are emptied of blood, the removal of effused fluid is
stimulated, and the muscular irritability allayed. The joints of the
limb are gently moved, care being taken that the broken ends of the
bone are not disp