Descriptions of operative technique are to be found in most modern textbooks of fracture treatment, and often in great detail; by comparison the details of manipulative technique are usually indicated in only the vaguest of general outlines. This is not surprising if manipulative treatment is regarded as an art rather than as a science, because an art is essentially something which defies description and is therefore to be learned only by practice and apprenticeship.

In this chapter an attempt is made to reveal the scientific basis of manipulative methods. Unless the teacher of manipulative technique is able to create a mental picture of a manipulation, the student may waste months of experience and much valuable material before he eventually discovers what others may long have known but have failed to communicate. These mental pictures should not be decried by an experienced operator if the interpretations here offered seem to him open to question; the student must adapt these pictures to suit impressions gained from his own practical experience and they will thus form a useful basis on which to build.

The Soft Tissues associated with a Fracture

When the student inspects the radiograph of a badly displaced fracture, such as that of a Pott's fracture of the ankle, he may well despair at the thought of manipulative reduction. Manual reduction of a case such as that illustrated in Fig. 38 would appear not unlike the assembling of a jig-saw puzzle in the dark. The solution of the difficulty emerges, and the precision of reduction is realised, only when the supreme importance of the soft tissues is appreciated.