because if there be then any remains of deformity, it must be owing to extension having been improperly directed. The remedy, therefore, is, to renew the extension, and direct it properly. 32. Hence, it follows, in general, that coaptation is here a feeble assistant towards reduction; that if it renders any service, it is only in cases of displacement laterally, or in the direction of the cross-diameter of the bone; and that it is by giving the proper direction to extension, by managing it according to the disposition of the muscles, and by knowing when to augment and when to slacken it, that the fragments are brought into regular contact. 33. If the inferior fragment has experienced a rotatory motion on its own axis outwards or inwards (18), the assistant ought, in making extension, to turn the limb very gradually in the opposite direction. 34. Extension was formerly attended with difficulties, which are rarely met with at the present day. Oftentimes, if we give credit to authors, it was altogether useless to endeavour, in the first instance, to reduce the fracture, and restore the limb to its natural length, as the contraction of the muscles rendered the operation absolutely impracticable. Hence, applications of a soothing and sedative nature were employed, previously to an attempt at reduction. The following circumstances have been assigned as the cause of these difficulties. The upper strap, irritating and drawing upwards the adductores and the rectus internus, drew the lower fragment in the same direction, while the semi-tendinosus, semi-membranosus, biceps, &c. being drawn downwards by the lower strap applied over them, drew the pelvis also downwards, and, consequently, the superior fragment connected with it. From this double action arose a double motion directly opposed to that which ought to be produced by extension. 35. There are still cases, where the muscles, in consequence of being irritated by projections or points of bone, by the efforts of the assistants, and by a morbid state of the nerves, increase their contraction to such a pitch that no practicable force can bring the fragments into apposition. What means are then to be employed? All those, in general, that diminish irritability, varied according to circumstances, such as diet, venesection, &c. In such cases, Desault obtained the most happy effects, by placing the limb in a state of continued extension; fatigued by the permanent tension in which they are thus kept, the muscles relax by degrees; their force diminishes; at length they yield, and the reduction is accomplished. § VI. OF THE MEANS OF MAINTAINING THE REDUCTION.