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application of the cast. A few days later the boy turned over on his stomach and otherwise threw himself about in bed. I found him with the cast slipped down and the callus broken loose. There was a decided angle forward and outward in the bone.

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C. W., aged 6. Fracture of Right Femur. Skiagraph taken eight weeks after injury. Lateral view. Fracture not united, but showing callus.

On July 8th the cast was removed, the patient was anaesthetised and an X-ray picture (No. 1) was taken by Dr. Childs. While yet under the anaesthetic, the limb was straightened down by strong traction, and an effort to get the bone again in position was made and another cast was applied, extension being made during the application and setting of the cast. He was kept in bed and the extension was kept on as best we could.

Picture No. 2 was then taken through the cast. Picture No. I show's very clearly, by the irregular surfaces, the second breaking, or rather the breaking and tearing of the soft callus.

Picture No. 2, as you see, shows considerable improvement over the first one, but is still very unsatisfactory. Dr. G. B. Packard saw the case in consultation at this time, and it was decided to apply a long extension hip splint, such as is generally used in hip joint diseases. This was done under anaesthesia after the fragments had been manipulated and gotten into as good a position as was possible. The limb was then placed on an inclined plane and extension was made by means of the key, and the patient was removed to the hospital and kept in bed. He complained of pain from pressure of the perineal strap, and in order to relieve this without lessening the extension, weights were attached to the end of the splint and allowed to swing from a pulley. Patient was kept in bed for six weeks, after which he was allowed to walk about, putting his weight on the splint. A few days later the splint was removed and he was allowed to walk without artificial means. The functional result is all that could be asked and the anatomical result is fairly good, as is shown by cuts 3 and 4. The measurements show practically no shortening. The patient is here and I shall be glad to have any who may desire to do so examine and measure the limb.

Case No. 2. G S.-A girl 6 years of age. Healthy and of healthy parents.

The following history was obtained from the parents: "On the 13th of July, 1902, while visiting in the mountains and while trying to climb into a wagon that was in motion, patient's foot was caught in the wheel in such a way as to fracture the left femur. The fracture occurred below the middle of the bone and was comminuted. One sharp fragment stuck almost through the skin, all but producing a compound fracture.

"The attending physician applied side splints of cardboard. On the third day these were removed and plaster of paris was applied. A week later, which was ten days after the accident, she was given crutches and allowed to walk, but instructed not to put any weight on the left foot. the cast was cut off and fixed so and the fracture was examined.

At the end of the second week that it could be laced on again, It was replaced and allowed to

remain one week, being three weeks from date or injury. At the end of this time we were advised to bring her to Denver."

On my first examination it was found that the callous was very large and there was marked outward and forward angular deformity, more than two inches of shortening, with no union at all in the bones.

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C. W., aged 6. Fracture of Right Femur. Skiagraph taken eight weeks after injury. Lateral view through plaster paris cast. Partial reduction.

I regret that an X-ray picture of this case was not taken before operation, but if in your examination of cut No. 1, of the case just reported, you imagine the under fragment drawn up and the fragments overlapping each other at least two inches with a broad, flat callus at the end of each fragment, you will have a

fairly correct picture of the case. Drs. Packard and J. M. Perkins, who were with me in the case, will bear me out in this statement. An anaesthetic was given and an attempt at reduction was made. This could not be accomplished, owing chiefly to the large callus at the ends of the bones. Patient was put to bed for several days with limb on an inclined plane and was treated

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C. W., aged 7. Fracture of Right Femur. Firm union. Skiagraph taken ten months after injury. Lateral view.

with weight and pulley. This failed to make any difference in the length of the limb and operative treatment was decided upon. On the 9th day of August she was operated upon. An incision was made over the point of fracture and a number of small fragments of bone, together with considerable callus which held

them together, were removed. The ends of the bone, which were sharp and irregular, were freshened and the two fragments of bone were wired together with medium sized silver wire. Two holes were drilled in each fragment and two loops of wire were used. In this, as in the previous case, the functional result is fine and the anatomical result, as shown by cut No. 5, is likewise quite satisfactory. By measuring this patient, who is also here to-night, you will find no appreciable difference in the length of the limbs. These children are both romping, healthy specimens, and appear to have no need for better limbs than those they now possess.

X-RAY REPORT OF ABOVE CASES.

By S. B. CHILDS, A.B.. M.D.,
Denver, Colo.

Professor of Anatomy, Denver and Gross College of Medicine: Surgeon to the Mercy Sanitarium.

A skiagraph shows the shadows cast upon a photographic plate by the denser structures with which the X-Rays come in contact and requires that the rays have sufficient penetration to pass through the area and be capable of outlining the shadows upon a fluorescent screen. As these rays diverge from the anode of the tube it is absolutely essential for the correct representation of the existing relations of the parts in question, that the target be accurately focused over the exact seat of suspected fracture or injury and that the central rays strike the object and the X-Ray plate at a right angle. Having taken these precautions in adjusting the tube and having placed it a sufficient distance from the plate to prevent magnifying the structures, we can depend upon the skiagraph for a practically accurate representation of the flat relations of the parts examined. It is the lack of attention to these details that has thrown discredit upon the reliability of certain skiagraphs; it is not the fault of the X-Ray, it is entirely the fault of the X-Ray operator.

As it requires some experience to interpret properly the significance of the different shadings found in an X-Ray picture, I take the liberty of briefly explaining the skiagraphs in the order in which they are enumerated.

Number I shows the typical appearance of an oblique frac

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