Treatment of Open Fractures.

While disease has varied in character with differing civilisations and the circumstances of living, injuries have varied only in extent and the methods of infliction; the problem of their treatment has remained the same. The treatment of an open wound involving injury to bone -surely one of the most primitive of injuries-always has and always will include treatment of the wound, of the part injured, and of the person; the essential demands of treatment have never altered, but only during the last 25 to 30 years has it been possible to organise these on an appropriate basis. A very brief review of the history of treatment, confined to this period, is not only instructive bitt imperative to a proper perspective of the subject; it covers the brief interval since the days when amputation, immediate or remote, was the usual ending of an open fracture, and during which certain principles of treatment have been more surely recognised and insisted on as a basis of treatment. Within the framework of these principles there are variations of opinion on the actual practice, on the details of technique, but such differences may be regarded as competitive in an effort to fulfil more adequately the requirements of the principle. For example, the different methods of splinting are matters of technical detail, the principle involved is immobilisation of a part injured; again excision of a recent wound is a principle of treatment, its extent is still a matter of opinion. The treatment of open fractures can be conveniently brought under two headings for the purposes of discussion.