. We have not found it
effectual in controlling the fragments, particularly in oblique
fractures, and it requires constant supervision and readjustment. It
consists of two pieces of wood extending from above the knee to an
inch or two beyond the sole, and a little broader than the maximum
diameter of the leg. These are rolled into the opposite ends of a
folded sheet, so as to form two sides of a box, of which the sheet
constitutes a third side. It is found advantageous to insert another
board, fitted with a foot-piece, between the folds of the sheet
forming the third side of the box, to add to the rigidity of the
splint, and to aid in controlling the foot. By folding one side of the
sheet somewhat obliquely, the box is made a little wider at the knee
than at the ankle, and so fits the limb more accurately.

[Illustration: FIG. 91.--Box Splint for Fractures of Leg.]

The limb is placed in this box, the sides of which have been carefully
padded. Ring pads are applied to take pressure off the condyles, the
head of the fibula, the malleoli, and the prominence of the heel, and
a large supporting pad is placed behind the tendo calcaneus. A folded
towel is laid over the front of the leg, forming a lid to the box, and
the whole is bound to the limb by three slip-knots. Finally, the foot
is fixed at right angles to the leg and slightly abducted by a
figure-of-eight bandage or a piece of elastic webbing. Sand-bags
placed alongside serve to steady the limb. In fractures of the lower
third of the leg, the box splint may stop short of the knee and the
limb may then be suspended in a Salter's cradle, which allows the
patient to move about more freely in bed.

[Illustration: FIG. 92.--Box Splint (applied).]

To prevent shortening in oblique fractures and in those near the
ankle-joint, where it is often difficult to control the lower
fragment, extension, applied by weight and pulley, or through a
Thomas' knee splint, may be of service. The strapping may be applied
only to the distal fragment, but we prefer to carry it to the upper
third of the leg. If the overriding of the fragments persists,
extension may be taken directly from the bone, the ice-tong callipers
gripping the malleoli or the calcaneus.

When the skin is damaged, as it so frequently is on the medial aspect
of the tibia, means must be taken to prevent infection.

Massage is carried out daily, and, to prevent stiffness, the ankle is
moved from the first. In the cours