On Fractures   

both bones with their epiphysis; sometimes the whole epiphysis is
slightly moved, and sometimes the other bone. These cases are less
troublesome than the same accidents at the wrist, if the patients
will have resolution to give them rest. The mode of treatment is the
same as that of the other, for the reduction is to be made, as of
the other, by means of extension, but greater force is required, as
the parts of the body concerned are stronger in this case. But, for
the most part, two men will be sufficient, by making extension in
opposite directions, but, not withstanding, if they are not sufficiently
strong, it is easy to make more powerful extension in the following
way: having fixed in the ground either the nave of a wheel, or any
such object, something soft is to be bound round the foot, and then
some broad thongs of ox-skin being brought round it, the heads of
the thongs are to be fastened to a pestle or any other piece of wood,
the end of which is to be inserted into the nave, and it, the pestle,
is to be pulled away, while other persons make counter-extension by
grasping the shoulders and the ham. It is also sometimes necessary
to secure the upper extremity otherwise; this if you desire to effect,
fasten deeply in the ground a round, smooth piece of wood, and place
the upper extremity of the piece of wood at the perineum, so that
it may prevent the body from yielding to the pulling at the foot,
and, moreover, to prevent the leg while stretched, from inclining
downward; some person seated at his side should push back the hip,
so that the body may not turn round with the pulling, and for this
purpose, if you think fit, pieces of wood may be fastened about the
armpits on each side, and they are to be stretched by the hands, and
thus secured, while another person takes hold of the limb at the knee,
and aids in thus making counter-extension. Or thus, if you prefer
it: having bound other thongs of leather about the limb, either at
the knee, or around the thigh, and having fastened another nave of
a wheel in the ground above the head, and adjusted the thongs piece
of wood adapted to the nave, extension may thus be made in the opposite
direction to the feet. Or if you choose, it may be done thus: instead
of the naves, lay a moderate-sized beam under the couch, and then
having fastened pieces of wood in this beam, both before and behind
the head, make counter-extension by means of thongs, or place windlasses
at this extremity and that, and make extension by means of them. There
are many other methods of making extension. But the best thing is,
for any physician who practices in a large city, to have prepared
a proper wooden machine, with all the mechanical powers applicable
in cases of fractures and dislocation, either for making extension,
or acting as a lever. For this purpose it will be sufficient to possess
a board in length, breadth, and thickness, resembling the quadrangular
threshing-boards made of oak.


PART 14
When you have made proper extension, it is easy reduce the joint,
for the displaced bone is thus raised into a line with the other.
And the bones are to be adjusted with the palms of the hands, pressing
upon the projecting bone with the one, and making counter-pressure
below the ankle with the other. When you have replaced the bones,
you must apply the bandages while the parts are upon the stretch,
if you possibly can; but if prevented by the thongs, you must loose
them, and make counter-extension until you get the bandages applied.
The bandage is to be applied in the manner formerly described, the
heads of the bandages being placed on the projecting part, and the
first turns made in like manner, and so also with regard to the number
of compresses and the compression; and turns of the bandages are to
be brought frequently round on this and on that side of the ankle.
But this joint must be bound more tight at the first dressing than
in the case of the hand. But when you have applied the bandage, you
must place the bandaged part somewhat higher than the rest of the
body, and in such a position that the foot may hang as little as possible.