ured by a bandage, and to its
lower ends are attached broad tapes which are buckled to a stirrup
through which traction is made by means of a cord passing over a
pulley fixed to an upright at the foot of the bed.

The lower end of the splint is suspended, and the counter-extension is
obtained by pressing the ring against the ischial tuberosity. To
prevent the ring overriding the tuberosity and pressing on the soft
tissues of the buttock, it is slung by the rope to a cross-bar above
the bed, _e.g._ the Balkan frame (Fig. 81).

In compound fractures the presence of a wound may prevent adhesive
plaster being used, and it is necessary to take the extension directly
through the bone. A posterior gutter splint is applied to prevent
sagging. After pulling the skin upward, a small incision is made over
the upper expanded border of each condyle, and the points of an
ice-tong calliper are made to grip the bone without penetrating into
the cancellous tissue. A cord attached to the handles of the calliper
passes over a pulley and supports the weight necessary to give the
desired amount of traction (Fig. 81).

An alternative method of exerting traction directly through the bone
is by means of Steinmann's apparatus (Fig. 76). In a moderately
muscular adult, a weight of from 12 to 15 pounds by means of strips of
plaster applied to the skin, or 10 to 25 pounds by direct traction on
the bone, should be applied in the first instance. The correct weight
to employ is that which maintains the length of the limb at its
normal, and is therefore liable to revision from time to time.

[Illustration: FIG. 76.--Radiogram of Steinmann's Apparatus applied
for Direct Extension to the Femur.]

_Hodgen's splint_ is a comfortable and efficient means of treating
these fractures, as it allows the patient a certain amount of
movement, admits of the part being massaged, and facilitates nursing.

It consists of a wire frame (Fig. 77) to one side of which a series of
strips of flannel about 4 inches wide are attached. Extension
strapping is first applied, and then the frame, which extends from the
level of Poupart's ligament to well beyond the sole, is placed over
the front of the limb, and the loose ends of the flannel strips
brought round behind the limb, and fixed to the other side of the
frame, convert it into a sling. The tapes attached to the extension
strapping are now tied to the end of the frame. By suspending the limb
in this splint by means