It is generally conceded that the "closed," or nonoperative, method of dealing with certain fractures is so unsatisfactory and uncertain that in selected cases "open" or operative reduction is justifiable. To avoid operating in that class of case in which closed reduction is impossible, resort is frequently made to skeletal traction by use of the tongs (calipers), a transfixion nail, or a metal band (stirrup).
This procedure of skeletal traction is, strictly speaking, an "open" or operative method; but, because the procedure is relatively simple, requiring a small incision, it is finding increasing favor and is properly regarded as an intermediate method between "closed" and "open" reduction. For the purpose of selecting a type of treatment in my own services we have for some time divided all fractures into two general "types," either of which may be simple (closed) or compound (open). Type 1 is that group in which the