IV. ON MALUNITED AND UNUNITED FRACTURES

THE conditions to wlich the terms "delayed union" and ''non-union " are applied may be difficult to distinguish, becauise often we find tlhat, even after montlis, osteogenetic clhanges leading to consolidation will take place in a fracture considered to be permanently united. If we are to av.id disagreeable experiences, we must recogniize that for various reasons, some of wlichl we know and some of whiclh are still unknown, a certain proportion of fractures takce longer to unite than others. Some years ago I was called to a distance to operate upon a fractured fernur. Tlle accident had occurred tlhree montlhs previously. The length and alignment were good, but the patient lhad some sugar in thie urine, and we decided, instead of operating, to place the limb, free from circular constriction, in a Tlhomas's bed splint (Fig. 1). Certain otlher proceduLres which I advise were nlot carried out, but in four weeks very firn consolidation had-occurred. This case affords an example of a clinical type. Thlere may be several weeks of apparent inactivity in callus formnation, and -then consolidation occurs quLite rapidly. If a practitioner takes care to niaintain a good 1eng4h jnd accurate alignmtient, lhe slhould looli forward clheerfully to a happyissue even if union is delayed. As a rule, tllis is exactly wlhat Fiobed sint le does niot do. At the end of tlhe fifth week lhe begins to feel nervous, lhe distLirbs tlle bone ends, modifies hiis methods, and by degree transforms inlto a permanent disability a condition wllich nmerely demnanded patience. Delayed itnion& is most comlmion in the middle of tlle femur, in the lhumiierus at the junction of the mn i d dlI e anid upper tlhird, and in the tibia and fibuila at tlhoir lower tliird.