of the neck of the femur in
old people. Under such circumstances it is necessary to expose the
fracture by operation, and to place the fragments in accurate
apposition, if necessary, fixing them in position by wires, pegs,
plates, or screws (_Op. Surg._, p. 52). Operative interference is
usually delayed till about five to seven days after the injury, by
which time the effect of other measures will have been estimated,
accurate information obtained by means of the X-rays regarding the
nature of the lesion and the position of the fragments, and the
tissues recovered their normal powers of resistance. Such operations,
however, are not to be undertaken lightly, as they are often
difficult, and if infection takes place the results may be disastrous.
Arbuthnot Lane and Lambotte advocate a more general resort to
operative measures, even in simple and uncomplicated fractures, and it
must be conceded that in many fractures an open operation affords the
only means of securing accurate apposition and alignment of the
fragments.

Both before and after operation, massage and movement are to be
carried out, as in fractures treated by other methods.

COMPOUND FRACTURES

The essential feature of a compound fracture is the existence of an
open wound leading down to the break in the bone. The wound may vary
in size from a mere puncture to an extensive tearing and bruising of
all the soft parts.

A fracture may be rendered compound _from without_, the soft parts
being damaged by the object which breaks the bone--as, for example, a
cart wheel, a piece of machinery, or a bullet. Sloughing of soft parts
resulting from the pressure of improperly applied splints, also, may
convert a simple into a compound fracture. On the other hand, a simple
fracture may be rendered compound _from within_--for example, a sharp
fragment of bone may penetrate the skin; this is the least serious
variety of compound fracture.

As a rule, it is easy to recognise that the fracture is compound, as
the bone can either be seen or felt.

The _prognosis_ depends on the success which attends the efforts to
make and to keep the wound aseptic, as well as on the extent of damage
to the tissues. When asepsis is secured, repair takes place as in
simple fracture, only it usually takes a little longer; sometimes the
reason for the delay is obvious, as when the compound fracture is the
result of a more severe form of violence and where there is
comminution and loss o